Derek Richards

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Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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Easter Break

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The Dental Elves will be taking a short break over Easter. Our next blog will appear on the 17th April.

Is a chewable toothbrush effective in children?

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This review comparing the effectiveness of a chewable toothbrush (CTB) with a manual toothbrush (MTB) in terms of plaque reduction included 7 RCTs. While no significant differences were found between CTB and MTB the availabel studies were small of short duration and of very low certainty.

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Clear aligners v fixed appliances for periodontal health

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This review of periodontal health maintenance and gingival recessions development in patients undergoing an orthodontic treatment with clear aligners (CA) or fixed appliances (FA) included 12 studies. The limited amount and quality of evidence was insufficient to assess whether CA were bettern than FA at maintaining periodontal health.

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Nocebo response in third molar analgesic trials

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This review estimating the nocebo response in dentistry from trials of analgesic treatment following third molar surgery included data from 50 RCTs. Adverse events (AEs) were roughly the same in placebo and active arms suggesting AEs may be attributed to the nocebo phenomenon.

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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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Peri-implant mucositis – patient performed adjunctive measures

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This review of patient-performed or administered measures used adjunctively to submarginal instrumentation for the management of peri-implant mucositis included 14 studies. The findings indicated that adjunctive measures reduced probing depth, bleeding on probing and plaque level reductions at 3 months and were in favour of adjunctive measures, which were plaque.

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Effervescent tablets for cleaning removable dentures

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This eview of the effectiveness of effervescent tablets in the cleaning and sanitising of removable prostheses included 23 RCTs. Six RCTs contributed to meta-analyses which indicate that use of brushing and effervescent tables reduce biofilm and bacterial conts more than brushing alone.

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Peri-implant mucositis – non-surgical treatments

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This review of the effectiveness of professional mechanical/physical treatment of peri-implant mucositis included 5 RCTs. None of the included RCTs was at low risk of bias so there is little evidence to recommend one treatment of combination of treatment. Additional high quality well reported studies are needed.

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Denture stomatitis – which interventions are most effective?

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This review of the comparative efficacy of interventions used for the treatment of denture stomatitis(DS) included 35 RCTs with 25 studies contributing to the meta-analyses. The findings suggest that topical antifungal agents produced the most effective clinical improvement and microwave disinfection and topical antifungals the best mycological resolution. Only one of the RCTs was at low risk of bias so the findings should be interpreted cautiously.

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Peri-implantitis – efficacy of different bone reconstructive therapies

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This review of the efficacy of different bone reconstructive therapies for peri-implantitis compared to access flap surgery at 12 months or longer. included 18 studies with 12 RCTs contributing to the meta-analyses. The findings suggest that compared with access flap surgery reconstructive surgery does not offer significant improvements at 12 months but the evidence is of low certainty.

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