Oral health plays a key role in general health and wellbeing and is important at all stages of life. The available evidence shows that oral diseases share important common risk factors with the four leading chronic disease – cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. Oral diseases such as tooth decay, periodontal (gum) disease and mouth head and neck cancer can be detected with the help of the pharmacy community delivering oral health promotion messages and information. Evidence has also shown that pharmacist-led continuity of care, can and does improve patient outcomes.
For some people, a visit to the dentist can be put on hold, as something non urgent, for a variety of reasons, and indeed, may only attend if they require treatment. However, people frequently visit their local pharmacy and will listen to advice from the Pharmacist who is well equipped to help. For example, currently it is possible to purchase a temporary filling material repair kit from a pharmacy if a loose filling/crown needs to be repaired (temporarily) before visiting the dentist. A pharmacist may be asked about denture repair kits for broken dentures, or to recommend appropriate over the counter pain medication in the case of a toothache (rinsing the mouth with warm salt water may also help), until the person visits a dentist.
Tooth Decay and Oral Hygiene
Tooth decay is the most widespread non-communicable disease according to the World Health Organization and can be traumatic for both child and adult, and may result in pain, lead to infection and result in hospitalisation and extraction of teeth under general anaesthetic. Good oral health is also essential for healthy ageing, a healthy mouth will improve general wellbeing and quality of life. Tooth loss and ill-fitting dentures in older people affects their ability to eat, speak or socialise properly. It also puts them at a higher risk for malnutrition, cardiovascular disease and infectious respiratory diseases such as pneumonia.
Poor oral hygiene and frequent consumption of sugary foods and drinks (cakes, biscuits, chocolate, sweets, fizzy drinks) are the main causes of tooth decay. Acidic foods and drinks like fruit juice and smoothies can also cause dental erosion. Tooth decay is largely preventable, and the pharmacist can play a key role in reinforcing messages about healthy eating and good oral hygiene. General advice for both children and adults is as follows:
• When a baby is born, the first set of teeth is already under the gums so a clean damp cloth should be used to wipe the gums after a feed. As soon as the first tooth appears brush twice a day (at night-time and one other time with a soft toothbrush and water, do not use toothpaste for under 2’s unless advised by a dentist).
• Parents/carers should supervise teeth brushing until the age of seven years old and use a pea-sized amount of fluoride toothpaste (at least 1000ppm) for 2–7-year-olds, twice a day.
• Spit out toothpaste but don’t rinse after brushing (as this will wash the fluoride off the teeth
• Adults, brush twice daily with fluoride toothpaste (at least 1000ppm) at night and one other time, spit out toothpaste and don’t rinse. Floss daily.
• Make healthy food choices by eating more fruit and veg and avoid sugary snacks and drinks between meals.
• Unflavoured milk and water are the best drinks.
• Read food labels for sugar content, less than 5g per 100g is considered a low sugar.
It is not only the physical removal of plaque that is important in oral hygiene practices, but also noting that fluoride in toothpaste gives the tooth enamel the potential to heal. The pharmacist can recommend oral health products such as toothbrushes (these should be changed when the bristles are worn, about every 3 months), fluoride toothpaste, interdental brushes, floss etc. However, it is also important that the patient is encouraged to seek oral health advice and a professional opinion from a dentist.
Gum Disease
Gum disease is caused by a build-up of plaque on the teeth and around the gums, causing red swollen gums which bleed when brushing. If left untreated, gum disease (or gingivitis) will progress to periodontal disease which causes bad breath, receding gums, wobbly teeth and, ultimately, loss of teeth. Smoking also increases the risk of periodontal disease, smokers are more likely to get periodontal disease and prematurely lose their teeth than non-smokers.
Poorly controlled diabetes increases the risk of periodontal disease development, which in turn can make it more difficult to control diabetes. People with diabetes should be encouraged to have a good oral hygiene routine and regular visits to their dentist.
It’s also worth noting that hormonal changes during pregnancy can make women’s gums more vulnerable to pregnancy gingivitis. Advice to pregnant women about their oral health during pregnancy is important to both the mother and baby. Studies suggest a link between poor oral health and women delivering pre-term, low birth rate babies. Making healthy choices can positively affect their baby’s development including their teeth.
Mouth Head and Neck Cancer
Mouth Head and Neck Cancer is the sixth most common cancer in the world. Smoking and drinking alcohol are the most important risk factors, alcohol plays a role in up to half of all cancers of the mouth, head and neck in men in Ireland. It is useful to able to be signpost to alcohol and smoking cessation support services such as https://www2.hse.ie/alcohol/ and www.quit.ie
Early detection saves lives so if a concerned customer has any of the following symptoms for more than 3 weeks refer them to their dentist or doctor:
A sore or ulcer in the mouth that does not heal, white or red patches inside the mouth, a lump in the mouth or neck. thickening or hardening of the cheek or tongue, difficulty chewing, swallowing or moving the tongue, numbness of the tongue or face, a persistent sore throat and hoarseness persistent nosebleeds and a stuffy nose or unexplained loose teeth.
A lesser-known fact is that the human papillomavirus (HPV) is also a risk factor for Mouth Head and Neck Cancer. Students in their first year of secondary school are offered the HPV vaccine as part of the school vaccination programme. For more information about mouth head and neck cancer, please see www.mouthcancer.ie
Medication
Some liquid medicines have a high sugar content. The Dental Health Foundation recommends sugar-free alternatives if they are available, especially where medicines are given frequently or are long term.
Dry mouth is a side effect of some medication. This is particularly uncomfortable and often gives rise to difficulty in speaking and eating and impacts negatively on quality of life. Furthermore, reduced saliva flow can give rise to an increased incidence of tooth decay, gum disease and also an increase in oral infection, such as candida albicans.
Saliva substitutes are generally available in pharmacies and useful if used just before eating, at night if you wake up because of dry mouth, or first thing in the morning. Sucking sweets regularly e.g., mints, boiled sweets or consuming sugary drinks can give temporary relief but will cause severe tooth decay in the absence of saliva. Chewing sugar-free gum may offer relief. We advise to limit the frequent consumption of drinks sweetened with sugar e.g., soft drinks, sugary tea, and also sugar-free drinks, because sugar/ acid content may cause tooth decay and erosion. Sipping water frequently, and with your meal is best (fluoridated tap water will help to prevent tooth decay).
Some people require nutritional supplements or fortified drinks to maintain their calorie input, and these can have a high free sugar content, putting them at further risk of dental caries, so recommend a sugar free option if suitable.
Stress
The current pandemic is stressful and is impacting people in different ways including their eating and snacking habits. Stress can cause a person to clench or grind their teeth resulting in the continuous loss of tooth enamel; a dentist may recommend wearing a bite guard during sleep. Emotional stress is a possible trigger for canker sores/mouth ulcers and customers may look for pain relief medication from their pharmacist. Encourage them to attend the dentist if mouth ulcers do not clear up within a few days, or if this is persistent and frequent enough to cause concern. Their dentist or GP may refer more severe cases to a specialist for a thorough investigation. People often reach for alcohol, or smoke more in times of stress or worry impacting negatively on oral health. Heavy use of alcohol increases the risk of acute respiratory distress syndrome (ARDS), one of the most severe complications of COVID-19. The World Health Organization states that smoking impairs lung function making it harder for the body to fight off coronaviruses and other respiratory diseases.
Sport
Injuries to teeth arise from accidents during normal everyday activities such as playing contact sports. Recommending to always wear a mouth guard is a great preventative measure. In the event that a person presents/contacts a pharmacy about a knocked-out tooth check this ‘Save That Tooth’ poster for advice on what to do:
https://www.dentalhealth.ie/ assets/files/pdf/savethattooth_ english.pdf
Support and Resources
The Dental Health Foundation is at the heart of oral health promotion for over 40 years and supports all health professionals, including Pharmacists, by providing evidence based best practice resources to increase awareness amongst the public, empowering them to make healthier oral and general health lifestyle choices. Having the right information on tooth tips, diet and general health will help keep teeth healthy for a lifetime. Good oral health is of vital importance to the general health of everyone in Ireland.
Health Promotion is about empowering people to take control of their own lives so make every contact count. For further information about the Dental Health Foundation and to download our free resources please see www.dentalhealth.ie or link in with us on Twitter, Facebook, LinkedIn.
Be aware of the factors that affect oral health and know where to go to get the best help and advice: www.dentalhealth.ie www.dentist.ie
For information about dental entitlements see www. citizensinformation.ie
Self- Care, Self-Aware …. Healthy Teeth for Life!
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