%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

What are the benefits and risks of using lasers to treat tooth hypersensitivity (short, sharp tooth pain)?

You can view up to 4 cases without signing up [Sign up for unlimited access](https://app.figure1.com/registration/new?redirect=/case-detail/6df3fa2a-4d1c-441e-a87f-ced74cf901f4)

Key messages

‐ Lasers may slightly reduce pain after 24 hours. They may reduce pain beyond 24 hours but the evidence is very uncertain.

‐ Lasers do not appear to cause adverse (unwanted) effects.

‐ We need future studies to strengthen the evidence and investigate the impact of laser treatment on quality of life.

What causes tooth hypersensitivity?

Tooth hypersensitivity is short, sharp pain that is not due to a dental disease or problem such as caries (holes in the teeth) and can occur when teeth come into contact with hot or cold food or drinks; cold air; or specific food or drinks such as sugar and fizzy (carbonated) drinks. It can also occur when people brush their teeth or receive professional dental care.

How can we treat tooth hypersensitivity?

An option for treating tooth hypersensitivity is to use laser (light) therapy. Lasers produce a narrow, focused beam of light that is applied to the painful tooth to treat it. Depending on the type of laser used, the treatment either aims to seal off the painful area, or to numb it.

What did we want to find out?

We wanted to find out if lasers work to treat tooth hypersensitivity, and whether they are associated with any unwanted (adverse) effects.

What did we do?

We searched for studies that compared lasers against a placebo (dummy treatment) or no treatment for treating tooth hypersensitivity. We compared and summarized the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did we find?

We found 23 studies of different durations up to 6 months that involved 936 people (2296 teeth) over 12 years of age with tooth hypersensitivity.

The evidence:

‐ suggests that lasers may slightly reduce pain after 24 hours compared to placebo or no treatment;

‐ is not robust enough to determine if lasers reduce pain beyond 24 hours or not; and

‐ suggests that lasers do not cause unwanted effects.

No studies investigated the impact of laser treatment on people’s quality of life.

What are the limitations of the evidence?

The main limitations of the evidence are that studies:

‐ reported inconsistent results;

‐ were conducted in ways that may have introduced errors into their results; and

‐ produced imprecise results when they were combined together.

Due to these limitations, we have little confidence in the evidence.

How up to date is this evidence?

The evidence is up to date to October 2020.

[Read the full Cochrane Review here:](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009434.pub2/full)

* * *

[Comment](https://app.figure1.com/case-detail/6df3fa2a-4d1c-441e-a87f-ced74cf901f4)

[Sign up to add a comment](https://app.figure1.com/registration/new?redirect=/case-detail/6df3fa2a-4d1c-441e-a87f-ced74cf901f4)

More about this case

Resolved

### Why you should join Figure 1

- Share your knowledge with our global community of healthcare professionals

- Get help from experts in your field

- Learn from our library of real-world cases and quizzes

[Sign up to explore now](https://app.figure1.com/case-detail/6df3fa2a-4d1c-441e-a87f-ced74cf901f4)

##### Similar cases

\\
\\
Background\\
It is common for people to feel pain in their lower back. When the cause of pain is unknown, we say that the pain is ‘non‐specific’. Pain that lasts for more than three months is considered to be 'chronic'.\\
Chronic non‐specific low back pain can be disabling. It can cause people to miss work. Often, people with chronic non‐specific back pain seek medical care.\\
Ultrasound therapy is the use of sound waves (vibrations) to treat medical problems. It is commonly used to treat low back pain. A healthcare provider rubs a hand‐held machine against the skin on the lower back. The machine produces vibrations that go through the skin. The aim is to deliver heat and energy to body parts under the skin, to reduce pain and speed up recovery.\\
This Cochrane Review aimed to find out whether ultrasound is effective for treating chronic non‐specific low back pain, and whether it causes any unwanted effects. Specifically, we wanted to know if ultrasound affected the following outcomes: pain, people feeling restricted in their daily life by pain, satisfaction with the treatment, well‐being, disability, and other unwanted effects.\\
What did we look for?\\
We looked for studies published up to January 2020 that:\\
• were randomised controlled trials, medical studies where people are randomly put into one of two or more treatment groups. This type of study provides the most reliable evidence about whether a treatment makes a difference;\\
• included people with chronic non‐specific low back pain who were aged 18 years or older;\\
• compared ultrasound (either alone or with another treatment) with a placebo (fake treatment) or other treatments for chronic non‐specific low back pain.\\
What did we find?\\
We found 10 studies that included a total of 1025 people treated for chronic non‐specific low back pain.\\
Most people in the studies had mild to moderate back pain, which means they may have found daily activities painful. They were treated in outpatient hospital departments or clinics, where they typically had six to 18 sessions of ultrasound therapy. Study participants were then followed for a period of time after the treatment (usually a few days or weeks).\\
Studies compared ultrasound to one or more of the following: placebo (five studies), no treatment (one study), electrical pulses (one study), manipulation of the spine (one study), osteopathy (one study), and laser therapy (one study). Three studies compared ultrasound with exercise to exercise alone. None of the studies was commercially funded.\\
Key results\\
There is little to suggest that ultrasound is an effective treatment for people with non‐specific chronic low back pain.\\
Ultrasound compared with placebo\\
We do not know whether ultrasound reduces average pain intensity because this has been studied in too few people, in studies that gave varying answers and were poorly conducted. Ultrasound probably makes little or no difference to the number of people in whom pain is reduced by 30% or more in the short term (i.e. less than three months after the start of the study).\\
Ultrasound probably makes little or no difference to people’s well‐being. It may make little or no difference to how much people feel restricted by their back pain in daily life, or to how satisfied people are with their treatment.\\
Ultrasound may have little or no impact on unwanted effects. We do not know whether ultrasound affects disability since no studies investigated this.\\
Ultrasound with exercise compared with exercise alone\\
We do not know whether ultrasound affects the outcomes of interest in this review because either no studies investigated them, or because the studies that did were imprecise or poorly conducted.\\
Certainty of the evidence\\
Based on the studies we found, there was mostly low‐ to very low‐certainty evidence that ultrasound makes little or no difference to pain and well‐being compared to placebo. For all the other outcomes and comparisons, we are less confident in the results we reported. This is because studies were too imprecise or were poorly conducted.](https://app.figure1.com/case-detail/1f346d4e-4f14-4f6e-b11e-e0bde676d471)

\\
\\
Why is this question important?\\
Primary angle‐closure glaucoma (PACG) is a type of glaucoma which is one of the leading causes of blindness worldwide. It occurs when there are problems with fluid drainage from the eye because the iris (the colored part of the eye) has blocked the drainage channels. A blockage can happen suddenly (acute PACG) or gradually (chronic PACG), causing a build‐up of fluid and raising the pressure inside the eye, which can damage the optic nerve and lead to vision loss. Treatment options include eye drops, laser treatment, and surgery. 'Lens extraction' is a type of surgery where the natural lens is replaced with an artificial lens. This also has the effect of opening up the drainage channels and may help to treat PACG. We reviewed the research evidence to find out how lens extraction compares to other treatments for chronic PACG.\\
How did we identify and evaluate the evidence?\\
We searched the medical literature for studies that compared lens extraction with other treatments for chronic PACG, compared the results and summarized the evidence from all the studies, and rated our confidence in the evidence.\\
What did we find?\\
We found eight studies comprising 513 eyes with chronic PACG that met our inclusion criteria. The studies followed participants for six to 69 months, and compared lens extraction against:\\
‐ laser therapy;\\
‐ lens extraction plus an injection of thick liquid to break iris adhesions with the aim of encouraging fluid outflow (viscogonioplasty, VGP);\\
‐ lens extraction plus breaking the iris adhesions mechanically, known as goniosynechialysis (GSL);\\
‐ trabeculectomy (creating a flap to facilitate fluid drainage); and\\
‐ lens extraction plus trabeculectomy.\\
These are the main findings of our review, focusing on results one year after treatment (unless otherwise stated).\\
\\
1. Lens extraction compared with laser therapy (1 study)\\
When compared against laser therapy, the evidence suggests that lens extraction probably:\\
‐ limits loss of visual field (the area that can be seen when the eye is looking straight ahead);\\
‐ reduces the number of pressure‐lowering medicines needed;\\
‐ open the drainage angle more; and\\
‐ makes little or no difference to quality of life, vision clarity, or eye pressure.\\
One person treated with lens extraction, and three people treated with laser therapy, experienced irreversible loss of 10 or more EDTRS letters of vision in the three years after treatment.\\
2. Lens extraction compared with lens extraction plus VGP (1 study)\\
When compared against lens extraction plus VGP, the evidence suggests that lens extraction may:\\
‐ reduce the number of pressure‐lowering medications needed;\\
‐ open the drainage angle more; and\\
‐ make little or no difference to clarity of vision.\\
There is uncertain evidence as to whether the two treatments have different effects on eye pressure. The study did not investigate the effects on visual field loss and quality of life.\\
Eye inflammation occurred in two people treated with lens extraction, and in four people treated with lens extraction plus VGP. Three people treated with lens extraction plus VGP experienced bleeding in the front of the eye.\\
3. Lens extraction compared with lens extraction plus GSL (2 studies)\\
When compared against lens extraction plus GSL, the evidence suggests that lens extraction:\\
‐ probably does not reduce the number of pressure‐lowering medications needed; and\\
‐ may make little or no difference to eye pressure.\\
The studies did not investigate the effects on visual field loss, eye drainage, vision clarity, and quality of life.\\
Bleeding in the front of the eye occurred in three eyes treated with lens extraction plus GSL.\\
4. Lens extraction compared with lens extraction plus trabeculectomy (3 studies)\\
When compared against lens extraction plus trabeculectomy, the evidence from one study suggests that lens extraction may make little or no difference to:\\
‐ eye pressure;\\
‐ the number of pressure‐lowering medications needed; and\\
‐ vision clarity.\\
There is uncertain evidence as to whether one treatment leads to more unwanted effects than the other. The studies did not investigate the effects on visual field loss, eye drainage, and quality of life.\\
What does this mean?\\
The evidence suggests that:\\
‐ lens extraction is probably a better treatment than laser therapy for chronic PACG;\\
‐ combining lens extraction with VGP or GSL may not work better than lens extraction alone; and\\
‐ there is uncertain evidence as to whether combining lens extraction with trabeculectomy makes a difference.\\
How‐up‐to date is this review?\\
The evidence in this Cochrane Review is current to 13 December 2019.](https://app.figure1.com/case-detail/6bc31892-caac-4afb-a16e-5ff475fc3021)

\\
\\
Key messages\\
– Ocrelizumab is a recently approved medicine to treat people with multiple sclerosis (MS). In relapsing‐remitting MS (where people experience flare‐ups of symptoms), ocrelizumab probably substantially reduces flare‐ups, may substantially reduce worsening of symptoms, and probably makes little or no difference to unwanted effects compared with interferon beta‐1a (a standard treatment for MS), 96 weeks after treatment starts.\\
– Compared to placebo after 120 weeks of treatment for primary progressive MS, ocrelizumab may reduce worsening of symptoms. Ocrelizumab probably increases unwanted effects but makes little or no difference to the number of serious unwanted effects.\\
– We need more, better‐designed studies.\\
We found four studies with 2551 people with MS. The largest study included 732 people and the smallest included 163 people. The studies were in countries around the world, but mostly in the USA. One study lasted for 24 weeks; two studies for 96 weeks; and one study for at least 120 weeks. Pharmaceutical companies funded the four studies.\\
Main results\\
Ocrelizumab compared with interferon beta‐1a for people with relapsing‐remitting MS, after 96 weeks of treatment:\\
– probably substantially reduces the number of people who had flare‐ups;\\
– may substantially reduce the number of people whose symptoms got worse;\\
– probably makes little or no difference to unwanted effects; and\\
– may substantially reduce the number of people who stopped having treatment due to unwanted effects.\\
Ocrelizumab compared with placebo for people with primary progressive MS, after 120 weeks of treatment:\\
– may reduce the number of people whose symptoms got worse;\\
– probably increases unwanted effects; and\\
– may make little or no difference to the number of serious unwanted effects and the number of people who stopped having treatment due to unwanted effects.\\
Our confidence in the results is moderate to low for several reasons. First, people dropped out of the studies unevenly, which meant more people had one treatment than the other. Second, there was not enough information about some of our points of interest to allow us to draw conclusions for outcomes. Finally, changes in symptoms shown by scans could have been due to causes other than disease progression.](https://app.figure1.com/case-detail/7f70658e-4a16-4e19-bc6f-cd227c42c05e)

\\
\\
Why are people sick after an operation?\\
Feeling sick (nausea) or being sick (vomiting) is a common unwanted effect of general anaesthesia—medicine that makes people unconscious and unresponsive so they don't move or feel pain during an operation.\\
Most unwanted effects of general anaesthesia, including feeling or being sick, happen immediately and stop after a few hours, although some people may continue to feel sick for up to a day. If people carry on feeling or being sick, they might have to stay in hospital longer than expected and may experience other unwanted effects or complications.\\
Women are more likely to be sick after an operation, as are people taking opioid painkillers, those who have had motion sickness, and those who have been sick after previous operations.\\
Medicines to prevent people from being sick\\
Medicines called antiemetics are given to prevent people from feeling or being sick. These medicines may be given before or during anaesthesia.\\
Antiemetic medicines are grouped into six main classes based on how they act. Combining medicines from different classes sometimes makes them work better.\\
Why we did this Cochrane Review\\
We wanted to find out which medicines work best to prevent people from being sick after an operation and cause the fewest unwanted effects. Some unwanted effects of antiemetic medicines include headache, constipation, movement disorders such as tremors, sleepiness, irregular heartbeat, and wound infection.\\
What did we do?\\
We searched for studies that looked at the use of antiemetic medicines in adults having general anaesthesia to prevent people from being sick afterwards.\\
\\
We looked for randomized controlled studies, in which the treatments people received were decided at random. This type of study usually gives the most reliable evidence about the effects of a treatment.\\
Search date\\
We included evidence published up to November 2017; in April 2020, we found another 39 studies, which are not yet included in the analysis.\\
What we found\\
We found 585 studies in 97,516 people who were given antiemetic medicines before or during general anaesthesia. People included in the studies were more likely to be sick after anaesthesia, as 83% were women and 88% were taking opioid painkillers. Most studies were conducted in Asia, Europe, or North America.\\
These studies either measured how many people were sick in the first 24 hours after their operation or how many unwanted effects were reported, or both of these outcomes. Most studies compared medicines (given alone or in combination) with a dummy (placebo) treatment.\\
We compared all antiemetic medicines with each other using a mathematical method called network meta‐analysis.\\
What were our main results and how reliable are these results?\\
Compared with placebo treatment, 10 out of 28 single medicines and 29 out of 36 combinations of medicines prevented people from being sick in the first 24 hours after their operation (282 studies). Combinations of antiemetic medicines generally worked better than single medicines given alone. However, aprepitant, casopitant, and fosaprepitant worked as well alone as most combinations of antiemetics. The single medicine that worked best in the ranking of all medicines was fosaprepitant, followed by casopitant, aprepitant, ramosetron, granisetron, dexamethasone, tropisetron, ondansetron, dolasetron, and droperidol.\\
We are confident that aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron prevent people from being sick. We are moderately confident about how well fosaprepitant and droperidol work, but this finding may change when further evidence becomes available. We are uncertain about how well casopitant, tropisetron, and dolasetron work.\\
Not all studies looked at serious, life‐threatening unwanted effects. We are uncertain how many of these effects were reported when taking an antiemetic medicine and whether serious, life‐threatening unwanted effects occur at a similar rate or are reduced compared to placebo (28 studies).\\
Of the best medicines with most reliable evidence for preventing being sick, granisetron and ondansetron probably made little to no difference in the occurrence of unwanted effects compared to placebo, whereas dexamethasone and droperidol may cause fewer unwanted effects than placebo. We are uncertain about unwanted effects with aprepitant and ramosetron (61 studies). We found no studies looking at unwanted effects for fosaprepitant.\\
We are less confident about unwanted effects of other antiemetic medicines because we found little reliable evidence about this. Our results for unwanted effects are likely to change when further evidence is available.\\
Conclusions\\
For people at higher risk, we found that some antiemetic medicines work well to prevent them from being sick after general anaesthesia. The best antiemetic medicines with reliable evidence were aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron, followed by fosaprepitant and droperidol.\\
However, we did not find enough reliable evidence about potential unwanted effects to rank these medicines reliably according to how well they are tolerated.](https://app.figure1.com/case-detail/873bcda9-d75c-43b0-b074-95e3803b85e2)

##### Trending now

\\
\\
A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\\
He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\\
On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\\
\\
A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\\
Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\\
\\
A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\\
\\
patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)