Oral Irrigation Devices: A Scoping Review.

OBJECTIVES: Self-performed oral hygiene is essential for preventing dental caries, periodontal, and peri-implant diseases. Oral irrigators are adjunctive oral home care aids that may benefit oral health. However, the effects of oral irrigation on oral health, its role in oral home care, and its mechanism of action are not fully understood. A comprehensive search of the literature revealed no existing broad scoping reviews on oral irrigators. Therefore, this study aimed to provide a comprehensive systematic review of the literature on oral irrigation devices and identify evidence gaps. METHODS: The Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were utilized to prepare the review. Four databases and eight gray literature sources were searched for English publications across any geographical location or setting. RESULTS: Two hundred and seventy-five sources were included, predominantly from scientific journals and academic settings. Most studies originated from North America. Research primarily involved adults, with limited studies in children and adolescents. Oral irrigation was safe and well-accepted when used appropriately. It reduced periodontal inflammation, potentially by modulating the oral microbiota, but further research needs to clarify its mechanism of action. Promising results were reported in populations with dental implants and special needs. Patient acceptance appeared high, but standardized patient-reported outcome measures were rarely used. Anti-inflammatory benefits occurred consistently across populations and irrigant solutions. Plaque reduction findings were mixed, potentially reflecting differences in study designs and devices. CONCLUSIONS: Oral irrigators reduce periodontal inflammation, but their impact on plaque removal remains unclear. Well-designed, sufficiently powered trials of appropriate duration need to assess the clinical, microbiological, and inflammatory responses of the periodontium to oral irrigation, particularly those with periodontitis, dental implants, and special needs. Patient-reported outcome measures, costs, caries prevention, and environmental impact of oral irrigation need to be compared to other oral hygiene aids.

Decision-making on listing new medicines for public funding in New Zealand: the case of 'new' type 2 diabetes medications.

Introduction New medicines for the management of type 2 diabetes became available internationally in 2005, yet only in 2018 did the first of these become available in New Zealand. Access to these new medicines in New Zealand is largely dependent on decisions made by the Pharmaceutical Management Agency (PHARMAC). Aim This study sought to describe the decision-making processes to better understand access to new medicines in New Zealand. Methods We conducted an analysis of publicly accessible information on therapeutic committee deliberations, prices of medicines and registration and formulary listing dates. Results Prices for the new diabetes medicines in New Zealand are lower than comparator countries, but access to them takes longer. Discussion Given that knowledge on efficacy, safety and quality is widely available to support decision-making on new medicines, differences in access to them between nations appears to depend on the fourth hurdle of cost. However, we suggest that a rush to market is the norm, that activities of the pharmaceutical industry and regulatory agencies are less transparent than desirable, and that greater focus on availability of safety data is required. Deliberations of PHARMAC therapeutic committees are robust yet protracted. Opportunities to expedite decision-making, as well as resolving inequities, may be worthy of examination.