Oral care is growing in terms of products and trends, but it’s often still not at the forefront of everyday Aussies’ minds. While lack of oral hygiene has a domino effect on the rest of the body, luckily pharmacists are in a position to help prevent those dominos from all falling down.
Saying that oral care is often a skipped healthcare category refers to a widespread lack of urgency among Aussies in keeping up to date on oral health research, and the poor level of discipline generally applied to taking proper care of their mouths.
Tooth decay affects Australians of all ages and remains a significant concern, considering it is largely preventable, according to Australian Dental Association (ADA) Oral Health Promoter and Sydney dentist Dr Mikaela Chinotti.
She points to research showing that more than 32 per cent of Australians over 15 years have untreated tooth decay, while only 10.7 per cent of adults over 15 years of age have never experienced tooth decay in their permanent (adult) teeth.
“For children, tooth decay remains a concern, as 34.3 per cent [of those] aged five to six have experienced tooth decay in their primary (baby) teeth, [and] 23.5 per cent of six- to 14-year-olds have experienced tooth decay in their permanent (adult) teeth,” Dr Chinotti said.
Who suffers from tooth decay?
Dr Chinotti points to certain groups being at greater risk of experiencing poor oral hygiene.
“[They] include those residing in rural and remote locations, Aboriginal and/or Torres Strait Islander Australians, and residents of residential aged care,” she said.
Reasons that seniors are more susceptible to poor oral hygiene include the deterioration of certain motor skills and lack of attention to this from those who look after them.
Dr Geraldine Moses, the consultant pharmacist to the ADA, says another reason is the sheer number of medications seniors take that have related side effects.
“As we age, it becomes a lot harder to manage your oral health if you can’t hold your toothbrush or see yourself in the mirror,” she said.
“Staff in aged care often don’t have time to examine people’s mouths, as they have other, more pressing jobs to do – like wiping bottoms, and administering medicines and food – so they aren’t checking that the patients have cleaned their teeth, and not helping to clean teeth, either.”
The breakdown of a cavity
Dr Chinotti describes a cavity as being the damage to teeth caused by certain types of bacteria inside the mouth.
“These bacteria use the sugar from the foods and drinks we eat as energy to create acid,” she said. “This acid attacks the surface of the teeth. Over time, if this keeps happening and there’s not enough protection, tooth decay can develop. Only once the tooth decay progresses enough inside the tooth for the outside tooth enamel to become unsupported will the tooth break open for a hole to be visible.
“Until this time, tooth decay can often not be seen, except by your dentist, and sometimes only with X-rays.”
Dry mouth and its role in tooth decay
One danger Dr Moses believes needs more attention is dry mouth, how it starts and the effect it can have on the rest of the body.
“People tend to think if your mouth is dry, so what? Drink some water,” she said. It’s a very serious condition, which, if it progresses, can lead to teeth falling out from deteriorated roots and gums, or they need to be pulled out.”
The teeth of people with dry mouths are more likely to decay, and such people may also be affected by decay along the gum line. However, this decay is still preventable through appropriate diet and lifestyle adoption, with proper teeth cleaning using suitable toothpaste being especially important.
Addressing treatment of dry mouth, in particular, Dr Moses says an increasing number of specialised, effective products in the oral health section of a pharmacy can be useful, and pharmacy staff should become familiar with how all these work.
“I feel pharmacies don’t really promote the oral health section of their merchandise,” she said. “For example, many oral lubricants are available now, not just the famous brands, but new oral gels, from the people who make tooth mousse.
“Tooth mousse can help remineralise your teeth if you’ve worn down the enamel from excessive brushing or drunk too much juice and if you’re prone to caries [holes in the teeth]. You can apply this dental cream every night before you go to bed, and it can help remineralise the enamel.”
Consequences
Dr Chinotti says tooth decay will lead to short-term discomfort in the form of sensitivity to sweet foods.
“Once the tooth decay is fixed, most often by a filling that replaces the damaged tooth structure, this discomfort will subside,” she said.
“Long-term, untreated tooth decay can lead to pain, infection and larger financial implications for the patient. Untreated tooth decay can continue to spread further into the tooth, where it may reach the nerve at the centre.”
She adds that infections can spread significantly from the mouth to other areas of the face, including the neck, and can be fatal.
“Anyone experiencing facial swelling must seek dental treatment as soon as possible,” she said.
Treatment
The severity of the tooth decay will determine what level of treatment should be involved, with small cavities being easily repairable with a filling from a dentist.
“Although relatively simple, every time a treatment is completed, that does cause damage to the tooth,” Dr Chinotti said, “and once a filling is placed, this commits the tooth to a lifetime of treatment, as no filling lasts forever.
“Once the tooth’s nerve is affected by the decay and it’s damaged beyond repair, the only treatment options are root canal treatment or removal of the tooth, and possibly replacing the tooth with an implant, denture or dental bridge. Both options require more time at the dentist and more cost to the patient.”
Dr Chinotti lists the ways in which people at home can help prevent tooth decay:
- Choosing toothbrushes with soft bristles.
- Using electric toothbrushes – “great options shown by research to give a better clean than manual toothbrushes”.
- Choosing toothpaste that includes fluoride.
- Using toothpastes that assist with specific purposes – for example, treating sensitive teeth or dry mouth, and teeth whitening.
- “Floss, flossettes and interdental brushes are all great options to clean between the teeth. Some patients may need to use a combination of options.”
Pharmacists and the power of prevention
When it comes to education in pharmacy, there can at times be a major gap in oral health. Dr Moses notes that when she asked a group of her pharmacy students how much they were being taught about oral health, they said they had only one lecture covering the topic.
“In pharmacy, we’re supposed to know everything about everything, so I don’t expect pharmacy staff to know all about oral health, but what I would love people to understand is that many in the general public are even more unaware and don’t necessarily know how to keep their mouth and teeth healthy,” she said.
“When I go to [dental] conferences, I’m always shocked by some of the stories, like children saying, ‘In our family, we only clean our teeth on Sundays’ or ‘we don’t really drink water, we only drink juice’.
“Many may wait until their teeth are bad or painful before they ask for help, so we need to be intervening earlier, starting the conversation and talking to people about their oral health.”
People tend to wait until it’s too late for such issues as dry mouth or tooth decay to be examined by a dentist, so it’s important that a pharmacist can step in, start the conversation and advise them not only to adopt better oral care techniques but also to visit a dentist earlier.
Dr Chinotti points to pharmacists being well placed to launch this all-important conversation with customers and patients.
“As well as encouraging good oral care and a nutritious diet, pharmacists are in a great position to ensure patients can care for their teeth when it comes to medication use,” she said. “Many medications can lead to dry mouth, which can, in turn, increase the user’s risk of tooth decay.
“It’s important to let patients know of this side effect, so they’re empowered in caring for their oral health. Pharmacists can help the dental profession in directing Aussies to visit the dentist.”
This is the same sentiment Dr Moses expresses in regard to pharmacists, medications and dry mouth.
She says pharmacists don’t have time to be able to speak with every patient in-depth about oral care, so it’s important for them to prioritise the conversations wisely.
“Pharmacists could prioritise people on medicines that cause dry mouth,” she said. “There are so many drugs that do, like anti-depressants and drugs for overactive bladders. Let them know that dry mouth is very serious but there are ways to treat and prevent the side effects.“
Dr Moses believes pharmacists should avoid assuming that patients are aware of their oral care problems.
“Start the conversation and you’ll be able to help people with their oral health in ways that are not only good for the patients but good for business as well,” she said.
This feature was originally published in the July issue of Retail Pharmacy magazine.
