Clinical experience, misunderstood concepts and frequently asked questions. Notes from many years of practice.
What is proven at home, and what is merely recommended: a Cochrane review of 96 studies found high to moderate certainty that toothpaste at 1,000 to 1,500 ppm fluoride reduces caries increment, while 35 randomised trials in 3,929 adults gave only low certainty that flossing added to brushing reduces gingivitis.
The periodontal link has been quantified: a meta-analysis of 14 studies put the pooled odds ratio for psychological stress and periodontitis at 1.78, and grinding is common in its own right, with awake bruxism in 22.1% to 31% of adults. How stress reaches the mouth, and what interrupts it.
The confidence question has been measured: a systematic review of 33 articles covering 9,409 patients found a moderate impact of oro-facial appearance on quality of life. So has the durability question: across 580 porcelain veneers followed up to 12 years, survival was 99% where the preparation stayed within enamel.
Dental anxiety is common and treatable, not a fixed trait: a meta-analysis of 31 population studies covering 72,577 adults put global prevalence at 15.3%, with 3.3% at a severe level, while pooled evidence from 173 randomised trials supports cognitive behavioural therapy. What changes the experience in practice.
Teeth whitening lightens enamel and dentine with peroxide gels; in 12 trials, adding in-office to home bleaching raised sensitivity without improving colour.
Home measures buy time, they do not treat the cause: the American Dental Association guideline on urgent management of pulpal and periapical dental pain prioritises immediate definitive dental treatment in all cases. What genuinely helps until then, and what makes things worse.
Staying inside enamel is not only a comfort question but a survival one: in a review of 580 porcelain laminate veneers in 66 patients followed up to 12 years, survival was 99 percent when the preparation stayed within enamel against 94 percent when only the margins were. What prepless can and cannot correct.
Single visit or several? A Cochrane review of 47 studies covering 5,693 teeth found no difference in radiological failure between single-visit and multiple-visit treatment. The one measured difference is short-term discomfort, reported more often within a week of single-visit treatment (risk ratio 1.55).
The burden is large: 1.1 billion prevalent cases of severe periodontitis worldwide in 2019. Treatment is mechanical first; across 28 studies systemic antibiotics added roughly 0.45 mm of extra pocket depth reduction, with more adverse events. What prevention actually consists of.
