No evidence that treatment of gum disease reduces the number of babies born before 37 weeks of pregnancy

Periodontal disease is a disease of the supporting tissues of the teeth that may affect the gums, periodontal ligament membrane, and bone around the tooth socket. It has been linked with infections, which some researchers believe could lead to or have an impact on a number of conditions, including problems in pregnancy. Periodontal disease is common in women of reproductive age, and gum conditions tend to worsen during pregnancy due to hormonal changes. The treatment involves bringing plaque on the teeth down to minimal levels, to reduce and resolve inflammation of the gums. It could involve counselling on oral hygiene measures, removing the plaque and calculus by using hand instruments (e.g. scale and polish) or ultrasound equipment (e.g. mechanical debridement), sometimes alongside the use of antibiotics or antiseptic mouthwashes or gels. If the nonsurgical treatment is not successful, surgery is sometimes required. This review assessed studies where pregnant women with gum disease were treated using a combination of techniques, with or without antibiotics. Continue reading

Treating all teeth within 24 hours for chronic gum disease

FMSGum disease or periodontitis is a chronic inflammatory disease that causes damage to the soft tissue and bone around the teeth. Mild periodontitis is common in adults with severe periodontitis occurring in up to 20% of the population. Non-surgical treatments based on the mechanical removal of bacteria from infected root surfaces are used in order to arrest and control the loss of the bone and tissue that support the tooth in adults suffering from chronic gum disease. These treatments can be carried out in a different area of the mouth in separate sessions over a period of several weeks (SRP), which is the conventional method, or alternatively, can be done within 24 hours in one or two sessions, which is termed ‘full-mouth scaling’ (FMS). When an antiseptic agent (such as chlorhexidine for example) is added to the full-mouth scaling the intervention is called ‘full-mouth disinfection’ (FMD). The rationale for full-mouth approaches is that they may reduce the likelihood of re-infection in already treated sites. This review is an update of one originally published in 2008, and considers the effectiveness of full mouth treatments. Continue reading

Treating chronic gum disease – can it help to prevent heart disease?

Heart diseaseGum disease (periodontitis) is a common chronic or persistent condition that can get worse over time. It involves inflammation of the gums, which surround and support the teeth, causing swollen and painful gums and in severe cases loss of the bone that supports the teeth. Clinical investigations have shown that there might be a link between chronic, ongoing gum disease and heart and blood vessel disease (cardiovascular disease). Some investigators believe that the treatment for gum disease, which gets rid of bacteria and infection and controls inflammation, might prevent the occurrence or recurrence of heart disease. Continue reading

Triclosan / copolymer containing toothpastes for oral health

ToothpasteGum disease and dental decay are the main reasons for tooth loss. Plaque (a film of bacteria) can build up on the teeth, leading to swelling and redness of the gums (gingivitis) which if left untreated can develop into a more serious form of gum disease (periodontitis). Periodontitis can cause pain, eating difficulties and tooth loss. The build up of plaque can also cause teeth to decay. Adding an effective and safe antibacterial ingredient to toothpastes could be an easy and low-cost answer to these problems. Continue reading

Is there a case for routine scale and polish?

ScalingScaling and polishing of the teeth may help to reduce deposits such as plaque (bacteria)  and hardened plaque (calculus or tartar). It may also reduce bleeding and inflammation of the gums. Many dentists and hygienists provide scaling and polishing for most patients at regular intervals, even if they are at low risk of developing gum disease.  For this review, scaling and polishing was defined as the scaling and polishing of the crown and root surfaces to remove deposits of plaque and calculus. Calculus is so hard that it cannot be removed by toothbrushing alone, and it is generally removed by the scale and polish treatment. Removal of hardened deposits is done with specially designed dental instruments or ultrasonic scalers, and polishing is done mechanically with special pastes.

Is there evidence that this practice is effective? This review considers the data from randomized controlled trials. Continue reading

Three new titles registered by the Oral Health Group

acupuncture needles

Acupuncture is one of the options for preventing gag reflex, but how effective is it compared to other interventions? A new Cochrane review will consider the evidence. Photo published under GNU Free Documentation License.

The Cochrane Oral Health Group‘s editorial team met last week to consider which new titles to register. OHG have had a number of submissions over the last six months, and three titles have been registered by the Group. The editors identified them as priority topics, and agreed that they did not significantly overlap with any existing reviews:

Interventions for the prevention of osteoradionecrosis of the jaws in patients receiving head and neck radiotherapy

This review will be led by Dr. Amri Azarpazhooh from the University of Toronto in Canada. He will be joined on the team by Dr. Michael Duchnay, Dr. Grace Bradley, Dr. Howard Tenenbaum, Dr. Prakeshkumar S. Shah and Dr. Hamid Reza Raziee, who are all also based at the University of Toronto.

Prevention of gag reflex for patients undergoing dental treatment

Dr. Eachempati Prashanti from Melaka-Manipal Medical College in Malaysia will lead this new review. Dr. P. Renjith George, Professor Nagraj Sumanth Kumargere, Dr. Laxminarayan Karanth and Dr. Htoo Htoo Kyaw Soe will also be on the on the author team.

Autologous platelet concentrates for regeneration of periodontal defects

This review will be a collaboration between authors based in Italy and India. Dr. Massimo Del Fabbro from Università degli Studi di Milano leads the team, his colleagues Dr. Valentina Ceresoli and Dr. Caterina Ceci will join him as authors. Dr. Silvio Taschieri from University of Milan IRCCS Galazzi Orthopaedic Institute is also an author. The author team is completed by Dr. Saurav Panda, Professor Sheeja Varghese, Professor Malaiappa Sankari, Professor N. D. Jayakumar and Dr. Surenda Ramamoorthi from Saveetha University, India.

We look forward to publishing the protocols in the near future, watch this space!

Controlling gum disease may help to control diabetes, but more research is needed

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Periodontal scaler

This week is National Diabetes Week. Did you know that looking after your gums may help to reduce your blood sugar levels if you are diabetic? Read more about our Review of the Month for June.

What was the research?

A systematic review of the evidence to find out whether treating gum disease in people with diabetes helps to lower blood sugar levels. The review looked at several different types of intervention to treat periodontal disease in diabetic patients.

They included:

  • Scaling (cleaning between the gums and teeth)
  • Subgingival curettage and gingivectomy (removal of inflamed or diseased gum tissue)
  • Flap surgery (cleaning the tooth roots and repairing bone damage)
  • Antiseptic mouthrinses, gels and toothpastes
  • Treatment with drugs such as antibiotics
  • Training people in oral hygiene measures.

Who conducted the research?

The research was conducted by a team led by Terry C. Simpson from Edinburgh Dental Institute in the UK, on behalf of the Cochrane Oral Health Group. Ian Needleman, Sarah H. Wild, David R. Moles and Edward J. Mills were also on the team.

What evidence was included in the review?

Data was extracted from 7 randomised controlled trials. The trials looks at the intervention compared to no intervention, placebo or “usual care”. 460 participants were included across the 7 trials.

What did the evidence say?

The evidence suggests that there may be small but significant improvements in blood sugar control from treating pre-existing gum disease in people with Type 2 Diabetes Mellitus. There was little data on people with Type 1 Diabetes Mellitus. The studies looked at ultrasonic scaling, antibiotics, root planing, and oral hygiene measures.

How good was the evidence?

Although seven trials met the inclusion criteria, only 3 compared the intervention with no treatment or “usual care”. Only two of the seven trials was at low risk of bias. The few studies available lacked the power to detect a significant effect, and the quality of the evidence was generally low.

What are the implications for dentists and the general public?

Periodontal therapy in individuals with diabetes might help to improve the management of their condition, and an oral health assessment should be recommended as part of routine care for diabetes. If diagnosed, trained oral health professionals should manage the periodontitis. Communication between professionals is important so that patients become aware of the importance of periodontal disease management to controlling blood sugar levels.

What should researchers look at in the future?

Both periodontal disease and diabetes are prevalent, and further studies examining the link between the two should be a public health priority. More larger scale randomized controlled trials are necessary, as the studies in this review were too small to show a significant effect.

Link

Simpson TC, Needleman I, Wild SH, Moles DR, Mills EJ. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD004714. DOI: 10.1002/14651858.CD004714.pub2.