Tongue scraping for treating halitosis.

BACKGROUND: Halitosis is used to describe any disagreeable odour of expired air regardless of its origin. Mouthwashes which disguise oral malodor are more socially acceptable and generally more popular than tongue scrapers. OBJECTIVES: To provide reliable evidence regarding the effectiveness of tongue scraping versus other interventions (including mouthwashes) to control halitosis. SEARCH STRATEGY: We searched the following databases: Cochrane Oral Health Group Trials Register (to 15th September 2005); the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3 2005); MEDLINE 1966 to September Week 1 2005; EMBASE 1974 to September 2005 (searched September 19th 2005). SELECTION CRITERIA: Randomized controlled trials comparing different methods of tongue cleaning to reduce mouth odour in adults with halitosis. DATA COLLECTION AND ANALYSIS: Clinical heterogeneity between the two included trials precluded pooling of data, therefore a descriptive summary is presented. MAIN RESULTS: This review included two trials involving 40 participants. Both trials were methodologically sound but included no data for the primary outcomes specified in this review. Secondary outcomes expressed as volatile sulfur compound (VSC) levels were assessed by a portable sulfide monitor in both trials. One trial showed reductions of VSC levels of 42% with the tongue cleaner, 40% with the tongue scraper and 33% with the toothbrush. Reduced VSC levels persisted longer with the tongue cleaner than the toothbrush and could not be detected for more than 30 minutes after the intervention in any of the groups. Differences were assessed by the Friedman and Wilcoxon signed rank tests with the level of significance set at P < 0.05. The second trial, in which differences in totaled rank values between groups were compared by the Dunn method alpha = 0.01, showed a reduction of VSC levels compared with baseline measurements of 75% with the tongue scraper and 45% with the toothbrush. Adverse effects in one trial were nausea (60%) and trauma (10%) with the toothbrush and all participants receptive to using the tongue scraper. Based on the independent data from these two trials there was a statistically significant difference between the effectiveness of either the tongue cleaner or the tongue scraper in reducing VSC levels when compared with the toothbrush. AUTHORS' CONCLUSIONS: There is weak and unreliable evidence to show that there is a small but statistically significant difference in reduction of VSC levels when tongue scrapers or cleaners rather than toothbrushes are used to reduce halitosis in adults. We found no high level evidence comparing mechanical with other forms of tongue cleaning.

Antibiotic use for irreversible pulpitis.

BACKGROUND: Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care. Apart from removal of the tooth the customary way of relieving the pain of irreversible pulpitis is by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, a significant minority of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis. OBJECTIVES: The objective of this review was to provide reliable evidence regarding the effectiveness of prescribing systemic antibiotics for irreversible pulpitis by comparing clinical outcomes expressed as pain relief. SEARCH STRATEGY: We searched the following databases: Cochrane Oral Health Group Trials Register and Pain, Palliative Care and Supportive (PaPaS) Care Group Trials Register to 6th September 2004; the Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library Issue 3 2004; MEDLINE (1966 to 6th September 2004); EMBASE (1980 to week 36 2004). SELECTION CRITERIA: This review includes one randomised controlled trial which compared pain relief with systemic antibiotics and analgesics, against placebo and analgesics in the acute preoperative phase of irreversible pulpitis. DATA COLLECTION AND ANALYSIS: Only one trial is included in this review, therefore pooling of data from studies was not possible and a descriptive summary is presented. MAIN RESULTS: One trial involving 40 participants was included in this review. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the 7 day study period. The between-group differences in sum pain intensity differences (SPID) for the penicillin group were (6.0+/-10.5), and for placebo (6.0+/-9.5) P = 0.776. The sum pain percussion intensity differences (SPPID) for the penicillin group were (3.5+/-7.5) and placebo (2.0+/-7.0) P = 0.290, with differences as assessed by the Mann-Whitney-Wilcoxon test considered to be statistically significant at P < 0.05. There was no significant difference in the mean total number of ibuprofen tablets (P = 0.839) and Tylenol tablets (P = 0.325), in either group over the study period. The administration of penicillin over placebo did not appear to significantly reduce the quantity of analgesic medication taken (P > 0.05) for irreversible pulpitis. AUTHORS' CONCLUSIONS: This review which was based on one methodologically sound but low powered small sample trial provided some evidence that there is no significant difference in pain relief for patients with untreated irreversible pulpitis who did or did not receive antibiotics in addition to analgesics.