Interventions for the treatment of keratocystic odontogenic tumours.

BACKGROUND: The keratocystic odontogenic tumours (KCOTs) account for between about 2% and 11% of all jaw cysts and can occur at any age. They are more common in males than females with a male:female ratio of approximately 2:1. Although they are benign, KCOTs are locally very aggressive and have a tendency to recur after treatment. Reported recurrence rates range from 3% to 60%. The traditional method for the treatment of most KCOTs is surgical enucleation. However, due to the lining of the cyst being delicate and the fact that they frequently recur, this method alone is not sufficient. Adjunctive surgical treatment has been proposed in addition to the surgical enucleation, such as removal of the peripheral bone (ostectomy) or resection of the cyst with surrounding bone (en-bloc) resection. Other adjunctive treatments proposed are: cryotherapy (freezing) with liquid nitrogen and the use of the fixative Carnoy's solution placed in the cyst cavity after enucleation; both of which attempt to address residual tissue to prevent recurrence. OBJECTIVES: To assess the available evidence comparing the effectiveness of interventions for the treatment of KCOTs. SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 17 March 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2015, Issue 2), MEDLINE via Ovid (1946 to 17 March 2015) and EMBASE via Ovid (1980 to 17 March 2015). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials comparing one modality of intervention with another with or without adjunctive treatment for the treatment of KCOTs. Adults, over the age of 18 with a validated diagnosis of solitary KCOTs arising in the jaw bones of the maxilla or mandible. Patients with known Gorlin syndrome were to be excluded. DATA COLLECTION AND ANALYSIS: Review authors screened trials for inclusion. Full papers were obtained for relevant and potentially relevant trials. If data had been extracted, it would have been synthesised using the fixed-effect model, if substantial clinical diversity were identified between studies we planned to use the random-effects model with studies grouped by action provided there were four or more studies included in the meta-analysis, and we would have explored the heterogeneity between the included studies. MAIN RESULTS: No randomised controlled trials that met the inclusion criteria were identified. AUTHORS' CONCLUSIONS: There are no published randomised controlled trials relevant to this review question, therefore no conclusions could be reached about the effectiveness or otherwise of the interventions considered in this review. There is a need for well designed and conducted randomised controlled trials to evaluate treatments for KCOTs.

A clinical study comparing the efficacy of light activated in-surgery whitening versus in-surgery whitening without light activation.

OBJECTIVES: This randomised controlled clinical trial assessed the efficacy of color change and sensitivity after in surgery whitening with and without light activation. METHODS: Twenty two patients were randomly assigned to one of two different groups: Group A--in-surgery bleaching with light activated 25% hydrogen peroxide gel followed by 2 weeks at home, night time bleaching with 10% carbamide peroxide gel in a customised bleaching tray. Group B--in-surgery bleaching with 25% hydrogen peroxide without light activation followed by 2 weeks at home, night time bleaching with 10% carbamide peroxide gel in a customised bleaching tray. The efficacy of tooth whitening was assessed by determining the color change associated with the six maxillary anterior teeth. Sensitivity was self-assessed with the use of a visual analogue scale (VAS). RESULTS: Overall, there was no significant difference in shade change between the two groups immediately after the in surgery whitening phase, and at one or two weeks post in surgery treatment. With regard to sensitivity immediately following the in surgery whitening participants in Group B reported a significantly higher level of sensitivity in comparison to Group A (p=0.03). CONCLUSIONS: There was no significant difference between the shade improvements achieved by the two whitening protocols tested throughout the 2-week period of the study (p>0.05). There was no statistical significant difference in sensitivity at the one and two week review periods, however, immediately after treatment participants in Group B reported a significantly higher level of sensitivity than participants in Group A (p=0.03).

Domestic violence screening and intervention programmes for adults with dental or facial injury.

BACKGROUND: Domestic violence exists in all communities across the world. Healthcare services have a pivotal role in the identification, assessment and response to domestic violence. As the face is a common target in assault, dentists and oral and maxillofacial surgeons are in a unique position to screen for domestic violence in the context of presentation of dental and facial injury. Owing to lack of training, dentists and oral and maxillofacial surgeons may not be the best persons to give advice to someone experiencing domestic violence. Improper advice such as encouragement to leave an abusive relationship may escalate the frequency of violence. It may be more appropriate to refer to specialist agencies for intervention and support. It would, therefore be useful to know whether screening and intervention programmes are effective. OBJECTIVES: (1) To assess the benefits and harms of intervention programmes employed to reduce and or prevent domestic violence in adults with dental and/or facial injuries. (2) To assess the benefits and harms of screening and the use of different screening tools in the detection of the proportion of adult victims of domestic violence who present with dental and/or facial injury. SEARCH STRATEGY: The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 18 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 to 18 May 2010), EMBASE via OVID (1980 to 18 May 2010), PsycINFO via OVID (1950 to 18 May 2010), LILACS via BIREME (1982 to 18 May 2010) and CINAHL via EBSCO (1980 to 18 May 2010). There were no restrictions regarding language or date of publication. SELECTION CRITERIA: Randomised controlled trials (RCTs) involving adults aged 16 years and over presenting with dental and/or facial injury relating to domestic violence in any healthcare setting. DATA COLLECTION AND ANALYSIS: Screening of eligible studies was conducted in duplicate and independently by two reviewers. Results were to be expressed as random effects models using mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval. Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS: No eligible RCTs were identified. AUTHORS' CONCLUSIONS: There is no evidence from RCTs to support or refute that screening for domestic violence in adults with dental or facial injury is beneficial nor that it causes harm. Screening tools to detect domestic violence exist but no RCTs have specifically evaluated their effectiveness for patients presenting with facial and or dental injuries. There is also lack of evidence (from RCTs) that intervention programmes are effective at reducing frequency of physical assaults and at reducing the severity of facial injuries.

Interventions for the treatment of keratocystic odontogenic tumours (KCOT, odontogenic keratocysts (OKC)).

BACKGROUND: The keratocystic odontogenic tumours (KCOTs) account for between about 2% and 11% of all jaw cysts and can occur at any age. They are more common in males than females with a male:female ratio of approximately 2:1. Although they are benign, KCOTs are locally very aggressive and have a tendency to recur after treatment, reported recurrence rates range from 3% to 60%. The traditional method for the treatment of most KCOTs is surgical enucleation. However, due to the lining of the cyst being delicate and the fact that they frequently recur, this method alone is not sufficient. Adjunctive surgical treatment has been proposed in addition to the surgical enucleation, such as removal of the peripheral bone (ostectomy) or resection of the cyst with surrounding bone (en-bloc) resection. Other adjunctive treatments proposed are: cryotherapy (freezing) with liquid nitrogen and the use of the fixative Carnoy's solution placed in the cyst cavity after enucleation; both of which attempt to address residual tissue to prevent recurrence. OBJECTIVES: To assess the available evidence comparing the effectiveness of surgical interventions and adjuncts for the treatment of KCOTs. SEARCH STRATEGY: Databases searched were: the Cochrane Oral Health Group's Trials Register (to 28th July 2010), CENTRAL (The Cochrane Library 2010, Issue 3), MEDLINE (from 1950 to 28th July 2010), and EMBASE (from 1980 to 28th July 2010). The reference lists of all trials identified were cross checked for additional trials. There were no language restrictions and several articles were translated. SELECTION CRITERIA: Randomised controlled trials comparing one modality of surgical intervention with another with or without adjunctive treatment for the treatment of KCOTs. Adults, over the age of 18 with a validated diagnosis of solitary KCOTs arising in the jaw bones of the maxilla or mandible. Patients with known Gorlin syndrome were to be excluded. DATA COLLECTION AND ANALYSIS: Review authors screened trials for inclusion. Full papers were obtained for relevant and potentially relevant trials. If data had been extracted, it would have been synthesised using the fixed-effect model, if substantial clinical diversity were identified between studies we planned to use the random-effects model with studies grouped by action provided there were four or more studies included in the meta-analysis, and we would have explored the heterogeneity between the included studies. MAIN RESULTS: No randomised controlled trials that met the inclusion criteria were identified. AUTHORS' CONCLUSIONS: There are no published randomised controlled trials relevant to this review question, therefore no conclusions could be reached about the effectiveness or otherwise of the interventions considered in this review. There is a need for well designed and conducted randomised controlled trials to evaluate treatments for KCOTs.