Mouthwashes: Alternatives and Future Directions.

This narrative review summarises "alternative" or "natural" over-the-counter (OTC) mouthwashes not covered elsewhere in this supplement and newly emerging products, as potential mouthwashes of the future. The "natural" mouthwashes reviewed include saltwater, baking soda, coconut oil, charcoal, propolis, seaweeds, and probiotics. Other than essential oils, it is apparent that their clinical effectiveness is still under debate, but there is some evidence to suggest that propolis reduces plaque and gingivitis. This review also covers the host immune response, via novel anti-inmmunomodulant mouthwashes, such as erythropoietin to reduce inflammation with oral mucositis (OM) after radiotherapy. The emerging concept of nanoparticle-containing mouthwashes, such as iron oxide, is further discussed for OM, this agent having the potential for more targeted delivery of chemical antimicrobials. Unfortunately, there are impacts on the environment of widening mouthwash use with more new products, including increased use of packaging, antimicrobial resistance, and possible detrimental effects on marine life. Further, there are roadblocks, relating to regularly approvals and side effects, that still need to be overcome for any OTC deivered immunomodulant or nanoformulation mouthwashes. Despite these caveats, there are many new mouthwashes under development, which could help manage major oral diseases such as caries, gingivitis, and periodontal disease.

Non-pharmacological pain relief during orthodontic treatment.

Data sourcesA comprehensive literature search in all languages was carried out. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (till 6 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2016, Issue 9), MEDLINE Ovid (1946 till October 6th, 2016), Embase Ovid (1980 till October 6th, 2016) and EThOS (till October 6th, 2016). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. Authors were contacted to clarify study information.Study selectionThe inclusion criteria of studies were defined as patients undergoing orthodontic treatment, up to 18 years of age. INTERVENTIONS: orthodontic treatment, exposure: non-pharmacological orthodontic pain intervention (low-level laser therapy, vibratory stimulation, chewing adjuncts, brain wave music or cognitive behavioral therapy and post-treatment communication 'text message'). OUTCOME: pain.Data extraction and synthesisTwo authors reviewed each study independently. A third author was used to resolve any disagreement on the eligibility of the included studies. The authors excluded papers that had unsuitable study design, and assessed the risk of bias on each paper they included. Data were combined using a random effect model and expressed results as mean differences (MD) with 95% confidence intervals (CIs).ResultsThe authors included 14 randomised controlled trials (RCTs) that randomised 931 participants. Intervention modalities included: low-level laser therapy (LLLT) (four studies); vibratory devices (five reviews); chewing adjuncts (three studies); brainwave music or cognitive behavioral therapy (one study) and post-treatment communication in the form of a text message (one study). Twelve studies involved self-report assessment of pain on a continuous scale and two studies used questionnaires to assess the nature, intensity and location of pain. The combined data from two studies involving 118 participants provided low-quality evidence that LLLT reduced pain at 24 hours by 20.27 mm (95% CI -24.50 to -16.04, P < 0.001; I² = 0%). LLLT also appeared to reduce pain at six hours, three days and seven days. The results for the other comparisons are inconclusive due to low evidence quality.ConclusionsThe overall results of the current study are inconclusive. There is low quality evidence that non-pharmacological interventions reduce pain during orthodontic treatment.