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Maintaining good oral health is essential, not only to avoid the risk of tooth loss and gum disease but also for general health and well-being. Gum disease has been associated with an increased risk of heart disease, diabetes that is harder to control, and also higher levels of inflammation in the body.
In June 2024, research by the Oral Health Foundation (OHF) revealed that three in four UK adults had experienced dental problems in the previous year – the most common being sensitive teeth, bleeding gums, toothache and dry mouth.
Karen Coates, a registered dental nurse, oral health educator and spokesperson for the OHF, says that community pharmacies are important in oral care. “Dental or GP practices may not always be available and when that happens, a person’s main port of call will be their local pharmacy or all their health needs,” she says. “When recommending products for a specific dental issue, pharmacists should check to see how long their customer has been having these problems. If the symptoms have lasted for more than three weeks, they should be referred to their dentist for further investigation.”
Unfortunately, research shows that many UK adults still don’t know how to look after their teeth properly – or, if they do, they don’t follow the recommended advice. Therefore, as well as advising on suitable oral care products, pharmacy teams should be able to dispel common myths and misconceptions.
“Brushing our teeth is a habit most of us have had since childhood,” says Dr Nigel Carter, chief executive of the OHF. “But it is not just about doing it – it is about doing it right. Brushing for at least two minutes with a fluoride toothpaste is essential because that is how long it takes to thoroughly clean every surface, reaching all the way to the back teeth and around crowns and fillings. Oral health is a commitment – and every second counts.”
For pharmacy teams, being armed with the correct information can help customers to avoid bad habits or make mistakes when it comes to looking after their teeth and gums.
Common myths and misconceptions
“I only need to brush once a day”
According to the OHF, only 68 per cent of UK adults stick to the recommended two times a day brushing regimen. People are almost twice as likely to skip brushing before bedtime than in the morning.
“Brushing only once a day significantly increases the likelihood of plaque build-up and development of dental problems,” says Carter. “The bedtime brush is arguably the most crucial of the day. Throughout the day, bacteria and food particles build up in the mouth, and failing to remove them before bedtime allows these harmful substances to wreak havoc overnight.”
“I can use mouthwash instead of daily brushing”
According to the Adult Oral Health Survey 2021: Health-related Behaviours report, published by the Office for Health Improvements and Disparities (OHID) in January 2024, 37 per cent of adults use a mouthwash. While this is an important addition to an oral care routine, it should not be used to replace daily brushing.
“Brushing with fluoride toothpaste and cleaning between the teeth is essential for removing plaque, preventing cavities and maintaining healthy gums,” says Laura Thompson, education and clinical programme co-ordinator at TePe. “Mouthwash can help kill bacteria and freshen breath, but it doesn’t remove plaque as effectively as brushing and flossing do. For the best oral health, brush the teeth at least twice a day and use mouthwash as a supplementary measure.”
“Brushing harder leaves teeth cleaner”
The best toothbrush should have a small to medium head and soft to medium filaments. There is no evidence that harder filaments can remove more plaque than softer ones or that brushing harder leaves the teeth cleaner.
“One of the most significant problems we are seeing today, especially among the younger generations, is tooth abrasion caused by brushing too hard and aggressively,” says Emma Nelson, dental hygienist at the Dental Referral Centre in Dronfield, speaking on behalf of oral care products company DenTek.
“Many people are not aware that teeth have layers – enamel and dentine. Brushing too hard wears down the enamel, exposing the dentine, which can lead to sensitivity and an increased risk of developing cavities. Add receding gums to this and you’ve got three very good reasons not to brush too hard. We would always recommend using an electric toothbrush, since this helps to control the pressure of brushing.”
“Sugar is the only cause of cavities”
In July last year, a survey by the OHF found that 13 per cent of UK adults are taking active steps to limit their sugar intake. However, sugar isn’t the only dietary cause of tooth decay. Salty snacks such as crisps, for example, can dry out the mouth, while carbohydrates break down into sugar after eating, which increases the plaque acids that attack tooth enamel.
“Cavities (or dental caries) are caused by a combination of factors,” says Laura Thompson.
“Inadequate brushing and interdental cleaning allow for greater plaque build-up and increased bacteria levels. Consuming food and drinks frequently throughout the day gives bacteria more opportunities to produce acid.”
“Smoking only affects how teeth and gums look, not how healthy they are”
The OHID report noted that only 8 per cent of adults had received advice from a dentist or member of a dental team about giving up smoking. However, smoking has a significant impact on oral health. As well as turning teeth yellow or even brown over time, smoking can increase the risk of gum disease, tooth loss, dry mouth and mouth cancer.
“The detrimental effects of smoking on teeth go far beyond the cosmetic,” says Emma Nelson. “Smokers are twice as likely to develop gum disease and are less able to fight it due to a weakened immune system. Smoking also reduces saliva production, creating the ideal environment for bacteria, plaque and tartar to thrive, increasing the chances of cavities and even tooth loss.”
“You should brush your teeth straight after eating”
Many people brush their teeth straight after breakfast or other meals, but this may harm tooth enamel.
Thompson says this is most likely to occur if someone has consumed acidic foods or drinks such as citrus, tomatoes or fizzy drinks. “It is better to wait at least 30 to 60 minutes after eating to let saliva neutralise the acids and re-harden enamel,” she says. “In the meantime, rinse the mouth with water or chew sugar-free gum to help remove food particles and freshen breath.”
“Dentists recommend children start interdental cleaning as soon as two teeth are touching”
“I don’t need to clean between my teeth if I’m brushing twice a day”
According to the OHF, using interdental products once a day to clean between the teeth is a crucial part of oral hygiene. It removes food particles and plaque which, if left untreated, could lead to gum disease. However, in the OHID’s report, only 30 per cent of adults said they used dental floss as an oral hygiene aid, while 21 per cent used interspace brushes, and 11 per cent used interdens, toothpicks or wooden sticks.
“Over 70 per cent of tooth decay starts between the teeth, but a toothbrush alone cleans just 60 per cent of the tooth,” says Nelson. “Oral hygiene products such as DenTek’s floss picks and interdental brushes are vital and can be introduced at an early age. In fact, dentists recommend children start interdental cleaning as soon as two teeth are touching.”
“Diet drinks are better for teeth”
The OHF says that water and milk are the most tooth-friendly drinking choices. Some drinks can cause or worsen tooth decay, enamel erosion and gum disease; this includes fruit juices and fizzy drinks – even ‘diet’ options.
Low or zero calorie fizzy drinks, for example, may not contain sugar, but they can be very acidic.
“Instead of sipping these drinks throughout the day, it is better to have them with meals,” says Nigel Carter. “Using a straw can minimise contact with teeth. Vitamins and minerals found in fruit juice can be great for overall health, but the levels of acidity and sugar can be detrimental for teeth. Constantly sipping fruit juice throughout the day can leave the mouth open to acidic attacks for a prolonged time.”
“I only need to see a dentist when my teeth hurt”
According to the OHF, toothache should never be ignored. It may be caused by tooth decay, gum disease, cracked or damaged teeth, sensitive teeth, abscesses or infections.
It is also important to see a dentist for regular check-ups, to prevent and treat all tooth and gum problems and spot any signs of oral cancer.
“We would always recommend having regular dental check-ups every six to 12 months, as a dentist can identify any potential problems and stop them from developing further,” says Nelson. “It is not advisable to only see a dentist when something is wrong, as preventable damage could already have been done to the tooth. Early intervention allows for the best outcome.”
“Tooth loss is inevitable as we age”
According to the OHID, tooth loss is more common in older people, as well as in deprived areas and among people who only visit a dentist when they have tooth problems or who don’t see a dentist at all.
“Many people keep their natural teeth for a lifetime with the right dental care,” says Thompson. “Brushing twice a day with a fluoride toothpaste and daily interdental cleaning can help keep teeth and gums healthy, and routine dental examinations will detect and address dental issues early before they become serious problems.”
“All whitening products damage teeth”
Not all whitening products will damage the teeth, but it is important that people buy reputable products that are approved by dental organisations and recommended by a dentist.
Whitening products vary in their formulations and effectiveness. Whitening toothpastes, strips and gels from recognised brands are formulated to be safe for regular use, but make sure that customers are using these products properly.
“Whitening toothpastes remove surface stains only by being slightly more abrasive than regular toothpastes,” says Nelson. “Over time, their use can cause enamel wear, leading to sensitivity or damage. We would always recommend seeking advice from a dental professional.”
Alzheimer’s disease and dental health
The MySmile study, led by the University of Bristol and funded by the National Institute for Health and Care Research (NIHR), is looking at whether improving oral health can slow memory loss in people with early-stage Alzheimer’s disease or mild cognitive impairment. This follows on from research which has found that Alzheimer’s disease can be linked to certain bacteria found in the mouth.
Porphyromonas gingivalis bacterium, which causes chronic severe gum disease (periodontitis), has been identified in the brain tissue of Alzheimer’s disease patients. The bacterium produces enzymes called gingipains, which release tau protein from nerve cells. Once released, tau clumps together and re-attaches to the nerve cells, forming neurofibrillary tangles. These tangles are a key marker of Alzheimer’s disease (although they can also be found in some other conditions). Gingipain enzymes can also contribute to the formation of amyloid beta plaques, which form on the brains of people with Alzheimer’s disease.
“Improving dental hygiene is good for all of us, and cleaning teeth twice a day reduces the oral bacteria in a person’s bloodstream,” says Professor Nicola West of the Bristol Dental School, who is leading the study. “We want to find out if a daily brushing routine could also help to protect against dementia.”
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