Armed to the teeth with best practice

Good oral health is fundamental to overall health and well-being. It can affect a person’s general quality of life. If oral health is less than optimal, it can affect the ability to eat and speak, compromise socialising, and result in pain, discomfort, and embarrassment.

Oral health refers to the condition of a person’s teeth and gums, as well as the health of the muscles and bones in their mouth.¹ Poor oral health—mainly involving tooth decay, gum disease and tooth loss—affects many Australian children and adults, accounting for 4.5 per cent of the burden that non-fatal diseases placed on the community in 2022. Oral health generally deteriorates over a person’s lifetime.

Many factors contribute to poor oral health, including:²

• Consumption of sugar, tobacco and alcohol.
• Lack of good oral hygiene and regular dental check-ups.
• Lack of fluoridation in some water supplies.
• Access to and availability of services, including:
  • Affordability of private dental care.
  • Long waiting periods for public dental care.

The most common oral diseases affect the teeth (tooth decay – caries) and gums (periodontal disease). Oral disease can destroy the tissues in the mouth, leading to lasting physical and psychological disability.² Tooth loss can reduce the functionality of the mouth, making chewing and swallowing more challenging, which in turn can compromise nutrition. Poor nutrition can impair general health and exacerbate existing health conditions.² This is associated with a number of chronic diseases, including stroke and cardiovascular disease, lung conditions, diabetes and oral cancers, and can have an adverse effect on pregnant women.

Maintaining good oral hygiene is necessary to maintain a healthy mouth. This involves effective, mechanical removal of bacterial plaque from the teeth and from between the teeth, every day.³ Plaque is a sticky film that forms on the teeth every day. Plaque is also called a ‘biofilm’ because it’s actually a community of living microbes surrounded by a gluey polymer layer. The sticky coating helps the microbes attach to surfaces in the mouth so they can grow into thriving microcolonies.

Plaque can be removed with daily brushing and interdental cleaning aids. When plaque isn’t regularly removed, it can accumulate minerals from saliva and harden into an off-white or yellow substance – tartar.⁴ This builds up along the gumline on the front and back of teeth and needs to be removed by the dentist. If tartar becomes infected along the gum line, this can cause gingivitis, a condition that, if left unchecked, can cause the gums to separate from the teeth. This can lead to:

• Injury to the soft tissue and bone supporting the teeth.
• The tooth becoming loose and unstable.
• Loss of the tooth if infection progresses.⁴

Patients need information and instruction about tooth brushing, flossing and interdental cleaning for optimal self-care of the teeth and gums.³

Good oral hygiene practices include:

• Brushing the teeth twice daily. 
  • Toothbrushes
    • It’s recommended that the teeth be brushed for around two minutes, moving the toothbrush in gentle, circular motions to remove plaque.
    • Toothbrushes with soft bristles are recommended for effective plaque removal.³ Hard bristle brushes should be avoided as these don’t improve the efficiency of plaque removal and can damage the gingival tissues and cause gum recession. They can also cause defects by abrading the tooth surface.³
    • The head of the toothbrush should be small enough to allow access to all areas. Most people don’t clean the inner surfaces of the lower teeth effectively. A toothbrush with a small head helps in accessing these surfaces, while the handle size and shape should suit the user’s dexterity.³
    • Although manual toothbrushes are available with soft, medium or hard bristles, all powered toothbrushes have only soft bristles.³ Powered brushes with a rotation oscillation action are the only type with adequate evidence of greater efficacy.⁵ Compared with manual brushes, in tests, this type of powered toothbrush showed modest improvements in reducing plaque and gingival inflammation scores and was considered to be ‘at least as effective’ as manual brushes.³ Powered toothbrushes are helpful for individuals with dexterity or disability problems and for carers of the elderly and infirm.³

• Toothpastes
  • Brushing with toothpaste doesn’t remove more plaque than brushing without paste.⁶ However, toothpastes and gels are excellent vehicles for delivering fluoride to tooth surfaces to prevent dental caries, as well as delivering other agents to promote remineralisation or reduce sensitivity of tooth surfaces.³
  • Fluoride in toothpaste is a leading defence against tooth decay. It works by fighting germs that can lead to decay, as well as providing a protective barrier for teeth.⁴
  • Whitening toothpastes can lighten stains and brighten teeth over time.⁴ However, they may be too harsh for people with sensitive teeth and gums, and may not remove tough stains.

• Floss or interdental aids
  • Dental flossing plus brushing removes more plaque from between teeth than brushing alone.⁷ Flossing is not merely about removing food from between the teeth. The aim is to ‘wipe’ the interdental tooth surfaces with floss or tape to mechanically dislodge the plaque biofilm.³
  • There are also floss-holding devices that require only one hand for operation and may be a preferable choice or more suitable for those with dexterity or disability problems, or for carers responsible for the oral hygiene of the elderly and infirm.
  • Although interdental wood sticks are effective for removing food particles, they’re less effective than dental floss for interdental plaque removal. In contrast, interdental brushes are effective in plaque removal. These are spiral brushes that can be pushed forwards and backwards through an interdental space below the contact point of the teeth.³

• Mouthwashes
  • Mouthwashes can help by:
    • Reducing the amount of acid in the mouth.
    • Cleaning hard-to-brush areas in and around the gums.
    • Re-mineralising the teeth.

• Brushing the tongue. 
  • Bacteria-containing plaque can also build up on the tongue. This can lead to bad mouth odour and other oral health problems. Gently brush the tongue along with the teeth. Brush back and forth and side to side, then rinse the mouth with water.

• Good diet. 
  • Drinking water after every meal is recommended. This can help wash out some of the negative effects of sticky and acidic foods and beverages in between brushes.
  • Eating fresh, crunchy fruit and vegetables not only provides added healthy fibre, but is also the best choice for teeth.
  • Have a diet high in calcium, including:
    • Dairy products – milk, cheese and yogurt.
    • Soy milk.
    • Tofu with added calcium.
    • Dark green, leafy vegetables.
    • Almonds.
    • Beans.
    • Canned fish.

• • Limiting sugary and acidic foods.
    • Sugar converts into acid in the mouth, and can then erode the enamel of the teeth and lead to cavities. Acidic fruit, tea and coffee can also wear down tooth enamel. Consume these in moderation.

• Visit the dentist at least twice a year. 
  • Even with stringent oral hygiene, visiting the dentist for cleanings and check-ups twice a year is recommended. A dentist can not only remove calculus and look for cavities but also spot potential issues and offer treatment solutions.

References:

1. AHMAC (Australian Health Ministers Advisory Council) 2017. Aboriginal and Torres Strait Islander Health Performance Framework 2017 report. Canberra: AHMAC.
2. NACDH (National Advisory Council on Dental Health) 2012. Report of the National Advisory Council on Dental Health 2012. Canberra: Department of Health and Ageing.
3. nps.org.au/australian-prescribe
4. healthline.com/health/dental-and-oral-health
5. Robinson PG, Deacon SA, Deery C, Heanue M, Walmsley AD, Worthington HV, et al. ‘Manual versus powered tooth brushing for oral health’. Cochrane Database of Systemic Reviews, 2005, issue 2. Art no: CD002281. DOI:10.1002/14651858.CD002281.pub2
6. Paraskevas S, Timmerman MF, vander Velden U, van der Weijden GA. ‘Additional effect of dentifrices on the instant efficacy of tooth brushing’. <itals>J Periodontology<itals> 2006; 77: 1522-7.
7. Kiger RD, Nylund K, Feller RP. ‘A comparison of proximal plaque removal using floss and interdental brushes’. J Clin Periodontal, 1991; 18: 681-4.

Written by Sue Holzberger. 

This feature was originally published in the July issue of Retail Pharmacy magazine.