Is it time to brush up on your knowledge so you are ready to answer a range of questions on oral health, from managing tooth sensitivity to stopping gum disease in its tracks?

 

Learning objectives

After reading this feature you should be able to:

• Advise customers on how to follow a good oral hygiene routine
• Recommend oral care products that suit individual needs
• Manage common oral health complaints

Public interest in oral health has surged in recent years due to coverage of oral health problems in the national media. The British Dental Health Foundation (BDHF) has reported a 155 per cent increase in visitors to its site during 2014 alone. To cope with this increased interest, pharmacists need to have the key facts about oral and dental health at their fingertips.

“I feel very strongly that there is huge potential and a real opportunity for pharmacies to dispense oral care advice, and that pharmacists and dentists should work to maintain more of a relationship,” says Nairn Wilson, professor of dentistry at King’s College London Dental Institute. So let’s look at some of the questions pharmacy staff could be asked.

Which type of toothbrush is best?

The BDHF recommends that adults use a small to medium sized brush that can reach all parts of the mouth, with soft to medium multi-tufted, round-ended nylon bristles or ‘filaments'. Studies show that electric toothbrushes are more effective at removing plaque than manual ones, especially ones that have oscillating and pulsating heads.

In addition, toothbrushes with large handled and angled heads are easier to use for people with a physical disability or Parkinson’s disease. Toothbrushes or electric toothbrush heads should be replaced as soon as the filaments curl or lose their straightness, which usually happens after about three months.

However, data from the latest Adult Dental Health Survey shows that one in six UK adults change their toothbrush or toothbrush head just once a year while one in five can’t remember the last time it was changed.

What should a good oral care routine involve?

It’s important to brush at least twice a day for at least two minutes with a fluoride containing toothpaste, says the BDHF, although some dentists recommend brushing for longer. Brushing before bed is particularly important to prevent plaque building up overnight, and when it comes to brushing in the morning, Dr Phil Stemmer, dentist and founder of the Teeth for Life practice, says teeth should be brushed before breakfast “as this coats teeth in fluoride before you eat”.

Dr Stemmer also advises against “wetting the brush or paste before brushing, as this will dilute the effectiveness”. All surfaces of the teeth should be brushed, using small, circular movements with the brush angled towards the gum margin. Interdental cleaning or flossing once per day is also important to remove food particles trapped between the teeth, helping to prevent bad breath and gum disease.

Mouthwash can help to remove more plaque and freshen breath, but it is best used at another time of day rather than immediately after brushing.

What causes sensitivity?

Tooth sensitivity occurs when the dentine layer of the tooth becomes exposed, either due to enamel erosion or gum recession. The dentine contains tubules that lead directly to the pulp, which contains nerves, and when exposed to pressures such as heat, cold or sweetness, can cause pain and discomfort.

Specially formulated toothpastes are available that manage sensitivity, either by blocking the tubules or building a protective layer over vulnerable areas of the tooth, while specialist soft-bristled toothbrushes are designed to be gentle on teeth and gums. Consumer research shows 71 per cent of daily toothpaste users have sensitive teeth yet only one in three buys toothpaste for tooth sensitivity.

Restricting sugary or acidic foods to mealtimes can help to protect the enamel from erosion by limiting acid attacks, while good oral care and avoiding toothbrush abrasion can help to prevent gum recession.

How harmful is sugar to dental health?

According to the World Health Organization (WHO), dental decay is the commonest chronic disease in the world and sugar is its biggest dietary cause. The latest Government figures show that more than three in every 10 children starting primary school in the UK do so with tooth decay, while a third of children aged 12 have visible dental decay.

A campaign group called Action on Sugar has been formed to increase sugar awareness among the public and reduce sugar content in foods. The group’s aim is to reduce the average intake of free sugars in the UK to less than five per cent of total energy intake. The group is also calling for fruit juices to be removed from the Government’s ‘five-aday’ list, following research showing that many children’s juices contain as much as six teaspoons of sugar.

Meanwhile, the BDHF and the Children’s Food Campaign are lobbying to introduce a 20p per litre duty on sugary drinks. “Added sugar has found its way into almost all food, and the use of sugar as a means to calm, entertain, or reward children has become normalised, whereas sugar should be an occasional treat,” says Professor Aubrey Sheiham, emeritus professor of dental public health and advisor to Action on Sugar.

To help people find sugar-free alternatives to certain foods and drinks, pharmacists can recommend the Smartphone app FoodSwitch UK.

How should I care for my children’s teeth?

A baby’s teeth should be cleaned as soon as the first tooth appears, despite the fact that milk teeth will be replaced by adult teeth. According to Professor Wilson: “Baby teeth determine the growth and development of the jaw, and ensure positioning of the permanent teeth. Teaching young children the correct brushing technique is a skill they’ll take with them throughout their life.”

The BDHF recommends using a smear of toothpaste containing fluoride at over 1000ppm for children under three years and a peasized amount with fluoride over 1350ppm for children over three years. Parents should choose toothbrushes for their children that have small heads and soft filaments, while brightly coloured brushes featuring timers or characters may help encourage children to brush.

Brushing should be made into a routine and children should be supervised until at least seven years of age. Taking babies to the dentist early will help familiarise them with the environment and detect problems early. 

Brushing teeth should be supervised until at least seven years of age

Brush teeth before breakfast as this coats teeth in fluoride before you eat

Why do I keep getting mouth ulcers?

Single mouth ulcers are usually caused by damage to the inside of the mouth, such as biting the cheek or abrasion from a toothbrush, loose filling or poorly fitting dentures. However, some people are genetically predisposed to clusters of recurrent mouth ulcers, which may be triggered by stress or certain foods.

Most mouth ulcers heal within 10 to 14 days and various OTC topical products are available to help manage the pain, including gels, ointments and lozenges containing topical analgesics or anaesthetics. Identifying and avoiding the triggers, or practising relaxation techniques may help to prevent outbreaks.

How can I control bad breath?

According to the BDHF, one in four UK adults regularly suffer from bad breath (halitosis). The problem is usually caused by hydrogen sulfide released from dental plaque, or may be due to smoking or strong-smelling foods and drink. Bad breath can be managed effectively by good oral care, including using interdental brushes and taking care to brush the tongue.

Chewing sugar-free gum between meals may also help, as this stimulates saliva production, while an antibacterial mouthwash can also be recommended. Denture wearers can avoid halitosis by brushing their dentures before soaking with an effervescent denture cleaner or soaking solution and brushing again.

 

What causes dry mouth?

Dry mouth (xerostomia) disrupts the flow of saliva through the mouth, causing unpleasant symptoms, including difficulty swallowing, coughing, cracked lips, a choking sensation, difficulty eating and talking, and waking during the night.

It usually occurs as a side-effect of certain medications (e.g. antihistamines, antidepressants, some beta-blockers, antihypertensives and diuretics) and can contribute to other oral health problems including tooth decay, gum disease and bad breath. 

A range of products, including, toothpaste, rinses and lubricating sprays, is available for dry mouth sufferers who should avoid oral care products containing sodium lauryl sulphate, as this can irritate the mucosa and exacerbate symptoms.

Why do my gums bleed when I brush my teeth?

Spitting out blood during brushing is “an early, classic sign of gum disease, which is otherwise often asymptomatic,” says Professor Wilson. Other signs include red, sore, swollen gums, a bad taste in the mouth and halitosis. If gum disease (gingivitis) progresses to the more serious form (periodontitis), sufferers may experience pain, loose teeth and difficulty eating.

Poor oral hygiene is a major risk factor for gum disease; however, research suggests that some people are more genetically susceptible to gum disease than others. Smoking also increases the risk by raising the level of bacteria in plaque and reducing blood flow to the gums. Other risk factors include diabetes, dry mouth and an impaired immune system.

Thankfully, by practising good oral hygiene most people will be able to slow the progression of gum disease so that they keep their teeth for life. Mouthwashes containing chlorhexidine or AE (ethyl lauroyl arginate) can be recommended for the management of gum disease, although chlorhexidine should not be used for longer than two to three days as it can cause tooth staining.

What should I take for toothache?

Toothache may have various causes, including dental decay, wisdom teeth erupting, gum disease, a gum infection, a tooth fracture or a damaged filling. If pain occurs when the mouth is opened wide, for example during yawning, then there may be a problem with the temporomandibular joint (jaw).

Decay does not normally cause pain unless a cavity has reached the dentine or the dental pulp. Toothache can be alleviated while waiting for dental treatment through oral analgesics (e.g. ibuprofen or paracetamol) or biting on cotton wool soaked in clove oil.