Most popular Dental Elf Blogs Jan – Mar 2023

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Topics covered in our most popular blogs in the first quarter of the 2023. included , selective caries removal, root canal dressings and pain management following dental extractions

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Music, audio-visuals or virtual reality for dental anxiety?

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This review of the effectiveness of relaxing music, audio-visuals (AV), and virtual reality (VR) in reducing dental anxiety associated with tooth extraction included 11 RCTs. The findings suggest that music performed better than VR and AV . However the limited number of studies and variation in anxiety scales, musical and visual interventions used means that the findings should be interpreted cautiously.

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Acute pain management following dental extraction

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This review and network meta-analysis (NMA) of pharmacological treatments for the management of pain subsequent to simple and surgical tooth extraction included 85 RCTs. There was moderate- and high-certainty evidence that for surgical dental extractions that ibuprofen 200 to 400 mg plus acetaminophen 500 to 1,000 mg was the most effective for pain relief.

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Alveolar osteitis and oral contraceptive use

Anti-epileptic drugs can influence the effectiveness of contraceptive drugs

This review assessing the risk of alveolar osteitis (AO) in in oral contraceptive users included 17 mainly observational studies. The findings showed an increased risk of developing AO in female oral contraceptive (OCP) users, RR = 1.98 (95%CI:1.42 to 2.76) compared to female non-OCP users

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Alveolar osteitis – local management interventions

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This Cochrane review update looked at local interventions used for the prevention and treatment of alveolar osteitis (dry socket) following tooth extraction. 49 RCTs were included providing moderate certainty evidence for chlorhexidine rinses and gel for probably reduction in dry sockets.

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Metronidazole for treatment of non-periodontal dental infections

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This review of whether metronidazole used as monotherapy or in addition to a β-lactam antibiotic offers any additional benefit over β-lactam monotherapy in non- periodontal dental infections includes 3 RCTs. The findings suggest that metronidazole does not provide superior clinical results compared to β-lactam antibiotics for the treatment of non-periodontal dental infections. However the evidence is limited and of low quality.

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Tooth extraction prior to head and neck radiotherapy and osteoradionecrosis risk

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28 mainly retrospective studies were included in this review which aimed to determine if tooth extraction prior to head and neck radiotherapy (RT )is associated with a reduced risk of developing osteoradionectosis (ORN). The findings showed a significant association of post-RT dental extractions with the risk of ORN development, odds ratio = 1.98 (95%CI: 1.17 to 3.35. However the certainty of the evidence was low to moderate.

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Third molar surgery – Lingual or buccal-based flaps?

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This review of postoperative discomfort, operative time, and wound healing in the short-term follow-up following surgical extraction of lower third molars with lingual- or buccal-based flaps included 7 RCTs. The quality of the included studies was limited and few differences were seen between the type of flaps.

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Alveolar ridge preservation techniques

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16 RCTs were included in this Cochrane review update of the effectiveness of techniques for alveolar ridge preservation (ARP) following dental extractions prior to implant placement. The findings suggest that ARP techniques may minimise the overall changes in residual ridge height and width six months after extraction, but the evidence is very uncertain

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Osteoradionecrosis incidence and the timing of dental extractions

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This review of whether the incidence of osteoradionecrosis differed between patients who have dental extractions before or after radiotherapy (RT) included 24 studies (19 retrospective 5 prospective). While the findings suggest that the incidence is similar if extractions are undertaken before or after RT the quality of the evidence is limited.

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