Improving oral hygiene

toothbrush oral hygiene

Pharmacists are being encouraged to increase awareness of the benefits of good oral health care by integrating key messages into discussions with patients, reports Lisa Wall.

Key points:

  • Pharmacists are well-placed to identify customers at risk of poor oral health, and should take every opportunity to educate those most at risk of oral health problems;
  • Customers should be reminded that practising simple health habits could prevent many oral health problems;
  • Rising dental decay rates in young children is related to changes in what, and how, some children eat; and
  • Pharmacists should take a more active role in identifying where medicines have significant potential to cause dental caries.

FOR COMMUNITY PHARMACY, at-risk patients may include those who are affected by certain medical conditions or use certain drugs that are linked with oral health problems.

Children may also be affected; despite it being preventable, research shows decay is prevalent in about 50% of children in Australia younger that six years of age.

“In Australia decay rates are higher now than they were a decade or two ago—we need to be a bit more than just embarrassed about that and start doing something about it,” says Dr Peter Alldritt, chairman of the Australian Dental Association’s Oral Health Committee.

“The easiest way to avoid tooth decay is to be aware of what you eat and drink and maintain healthy oral hygiene habits,” he says.

Dr Alldritt says there are plenty of opportunities for pharmacists to broach the topic of oral healthcare with their customers.

“And it’s most important that pharmacists take these opportunities to educate those most at risk of oral health problems,” he says.
Take, for example, people with diabetes. “Pharmacists know which of their customers have diabetes because they are coming in for their medication,” he says.

“There are very strong links between diabetes and poor oral health—a diabetic is more likely to have periodontal disease than a non-diabetic and poorly controlled diabetes aggravates the problem of gum disease as well.

“Likewise having poor oral health makes an individual’s diabetic status worse so encouraging people with diabetes to have good oral health and get to the dentist and have proper cleaning done is actually going to improve their diabetic health as well,” says Dr Alldritt.

Starting early

Dr Alldritt says practising simple health habits could prevent many oral health problems, yet many people still needed reminding of the basics such as:

  • brush teeth twice a day;
  • floss teeth daily;
  • eat a healthy balanced diet; and
  • visit the dentist for regular checks.

The Australian Dental Association says good oral hygiene practices need to start as soon as a child is born. Dr Alldritt says key messages for parents of babies and toddlers that pharmacists can reinforce include:

  • gently wipe babies’ gums with a moistened soft cloth once a day;
  • once a baby’s primary teeth start to appear use a toothbrush designed for babies to gently massage their teeth and gums;
  • up to the age of 18 months a baby’s teeth should be brushed with plain water once a day after the last feed in the evening;
  • low-fluoride toothpastes developed for children can be introduced from the age of 18 months;
  • encourage the child to spit out the excess toothpaste;
  • adult toothpastes which have a higher concentration of fluoride can be introduced from the age of six;
  • children should begin to learn how to brush their own teeth from around the age of four but will still need an adult’s guidance until about the age of eight when they have developed the skills to properly clean their teeth;flossing should be introduced the children when they are about two and a half years old;
  • the recommendation for a child’s first dental visit is one year of age; and
  • The dentist will advise how often the child should visit based on their risk factors for decay.

Dr Alldritt says there are times when dentists may recommend children go straight to adult-strength toothpaste—usually when a child was not living in a fluoridated water area or when they were deemed at high risk of decay because they already had a cavity or there were dietary problems.

Dr Alldritt says despite all the oral health messages, dental decay rates in young children were rising—and this was related to changes in what, and how, some children eat.

He points out fewer children are drinking fluoridated tap water and more children were consuming sugary, processed foods and drinks.

“There’s a reason why half Australian kids have got tooth decay before the age of six and it’s not just about brushing… it’s about poor diet,” he says.

“Even though many people know about the importance of a healthy diet, many are not aware of where sugars are hidden.”

It’s also important to be aware of how babies and toddlers are drinking as this was a major cause of decay. “Parents should be reminded not to use bottles or sippy cups filled with juice or milk as a pacifier. The child needs to learn how to drink and move on—they are not to carry the bottle or the cup around with them sipping on them constantly because they are just bathing those teeth and gums in a sugary liquid for a long time,” says Dr Alldritt.

Putting a baby to bed with a bottle of milk should also be out of the equation for the same reason, he says. Also, Dr Alldritt says, it seems parents are letting good oral healthcare habits slip.

“There has also been an increase in the number of parents who report their children only brush once a day.

“They say to us ‘I’m just really busy’, ‘I haven’t got time to brush my kids’ teeth twice a day’…

“I appreciate parents are time poor but its only two minutes in the morning and two minutes at night.

“I say to them ‘you have to find time for it, its part of your responsibility as a parent,” he says.

Medicines Consultant drug information pharmacist, Mater Health South Brisbane and consultant pharmacist to the Australian Dental Association (ADA) Dr Geraldine Moses would like to see pharmacists taking a more active role in identifying where medicines have significant potential to cause dental caries. “I don’t think the average person thinks about how medicines impact on their teeth very much.”

There are a lot of medicines that contain a load of sugar, she adds.

“Probably the one many people don’t think too much about are those gummy bear vitamins—choc-a-block full of sugar.”
Liquid preparations and most chewable tablets are also high in sugar, says Dr Moses.

“There’s a well-known calcium tablet that is full of sucrose and dextrose but because it is a medicine people don’t think it is going to have sugar in it.

“Dentists have told me about women who clean their teeth before going to bed at night, then they chew or suck on this calcium tablet which means there is sugar all over these women’s teeth all night long,” she laments.

Many medicines also caused dry mouth. “Pharmacists know about dry mouth but we probably don’t do enough about it,” says Dr Moses.

“It could be as simple as asking people about dry mouth and educating them that they can do something about it—drinking more water for example or advising them about the dry mouth remedies that are available.”

Besides causing unpleasant symptoms, dry mouth also increases a person’s risk of gum disease, tooth decay and mouth infections such as thrush.

“People should be encouraged to do something about dry mouth not only to make them feel more comfortable but to look at it as a way to help them preserve their teeth,” says Dr Moses.

Dr Moses says antihistamines are probably the most common medication causing dry mouth.

“They are in many cough and cold remedies… many people use them for sleep—they sneak into people’s lives without people recognising them as an antihistamine that would therefore cause dry mouth,” she says.

Dr Moses says it’s also important for pharmacists (and dentists and oral surgeons) to be aware of medications that have been implicated in the development of osteonecrosis of the jaw.

Osteonecrosis of the jaw (ONJ) occurs when the jaw bone is exposed and begins to starve from a lack of blood. The bone begins to weaken and die. ONJ is associated with cancer treatments (including radiation), infection, steroid use or potent anti-resorptive therapies that help prevent loss of bone mass.

Most cases of ONJ happened after a dental extraction so it’s important for anyone who is taking these medications to be aware of the risk, says Dr Moses.

“Patients should have a full dental assessment before going on these drugs.

“Patients also need to understand they have to tell their dentist about any medications they are on,” she says.

Dr Moses says she would like to see a lot of the work she does as consultant pharmacist to the ADA backed up by colleagues in the community.

She currently takes half-a-dozen enquiries a day from dentists through the ADA PharmaAdvice service ranging from drug interactions and side effects to legal issues and resolving conflicting advice.

“Dentists are just like us [pharmacists]; they are often working in isolation and it can be hard to keep up.

“But you can glean a lot by consulting with others so reach out to these guys and share ideas and support each other in your clinical practices so you aren’t isolated and alone,’ she said.

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