A person’s smile is one of their most defining features, but a considerable number of people don’t take good care of their teeth, putting them at risk of serious oral and general health problems. With a lot of time on their hands at the moment, pharmacy customers can take stock and focus on their oral health

A worrying number of people in the UK have poor oral hygiene, with a third of adults suffering from regular dental pain. And problems often start at a young age, as one in four children reportedly have tooth decay by the time they start school.

Perhaps even more concerning is the fact that a recent survey looking at basic life skills in primary school leavers by Tic Watches found that one in 10 children leave primary school unable to brush their own teeth. Dr Nigel Carter, chief executive of the Oral Health Foundation, comments that “learning to brush our own teeth should be one of the first life skills we learn as youngsters.”

Tiny smiles

Engaging children in good dental practice from an early age creates habits that last into adulthood. Louise Davies, winner of the Infant Care Champion category at the 2019 Recognition of Excellence Awards, says it is important for pharmacy staff to keep an eye out for children who are looking at the range of toothbrushes and talk to them about their favourites. Louise tries to encourage parents to let the children choose their own toothbrush. It might be their favourite colour or feature their favourite animal, but it keeps them engaged and means that they are more likely to want to brush their teeth every day.

In some cases, it has been found that children brush more often due to the novelty of using an electric toothbrush. There are options available for children, and it can be a great tool to encourage brushing. There are also free smartphone apps available that play two minutes of music to bring some extra excitement to oral hygiene. Every child will be different and there are several suggestions that pharmacy teams can make
to get them excited to brush their teeth.

Louise’s number one tip is to “make it fun”. When talking to parents about tooth brushing with their children, she often suggests face pulling competitions during brush time, such as who can pull the biggest smile and who has the biggest open mouth. Playing games like this makes the two minutes of brushing fly past and can also help to ensure children are brushing all of their teeth evenly.

One in four children reportedly have tooth decay by the time they start school

Delving into dietary advice

As well as adopting a good oral care regime from a young age, another important consideration when it comes to maintaining good oral health is diet. 

The sugars that are in chocolate, sweets and soft drinks generate acids that can gradually dissolve the enamel layer of the teeth. Frequent consumption of sugar greatly increases the risk of tooth decay, as acids remain in the mouth and teeth do not have time to recover. 

In April 2018, the UK Government introduced the sugar levy as a measure to reduce sugar intake across Britain. Soft drink manufacturers have responded by cutting the levels of sugar in drinks by 29 per cent. When plans to introduce the tax were announced, around 52 per cent of eligible soft drinks contained enough sugar to be taxed. By February 2019, only 15 per cent of eligible soft drinks were still liable for the tax. Mick Armstrong, chair of the British Dental Association, has hailed the success of the tax, commenting that it has “earned its stripes”. He also encourages the Government to invest a small percentage of the estimated £300 million the sugar levy has raised into a supervised brushing programme for children in the greatest need.

One of the most important messages pharmacy teams can give customers is to remember that how often they consume sugar is just as damaging as the amount. Food packaging labels now come with an easy guide to keep track of the health information, including sugar content. The following tips can also be used to help combat a sugary diet:

• Only have fizzy or acidic drinks at mealtimes to reduce the amount of acids on the teeth
• Diet drinks are just as acidic and can still cause tooth decay, so these too should be consumed with caution
• Use a straw to avoid acidic or sugary drinks touching the teeth
• Drink milk after a meal to help cancel out acidity
• Wait for at least an hour after eating or drinking to brush your teeth
• Brush your teeth last thing at night to allow the fluoride in toothpaste to work overnight
• Keep an eye out for less obvious sugary drinks such as fruit juice and limit intake of these.

Fighting tooth and nail

Tooth decay is the most common chronic disease worldwide and is caused by plaque and acid on the teeth, which damages the enamel. This can cause sensitivity and can lead to the need for dental procedures such as fillings. The first step in the fight against tooth decay is a proper brushing regimen and Dr Carter believes pharmacy teams have a crucial role to play as frontline healthcare providers. 

“It is vital to encourage brushing twice a day, with a fluoride toothpaste. It is so important for oral health in general and no routine is complete without it. Daily cleaning between your teeth, with interdental brushes or floss, is also very important for maintaining healthy gums. Giving teeth and gums the daily care they need is something that takes a relatively small amount of time, but it can make a huge difference,” he explains. “Encouraging the public to maintain regular visits with their dental team is also essential. They can play a role in treating gum disease and providing guidance on correct home care to look after gums and teeth between visits.”

Using products like electric toothbrushes and water flossing devices is also encouraged by the Oral Health Foundation. Electric toothbrushes are proven to be more effective at removing plaque and are considered especially useful for disabled or elderly people, as they require less motion from the user. 

Tooth decay is the most common chronic disease worldwide

Getting to know gum disease  

The NHS states that most adults in the UK have gum disease to some extent. In its early stages, this is known as gingivitis and can cause the gums to bleed when brushing, although there is not necessarily any accompanying pain.

If gum disease is left to develop, it can lead to several unpleasant symptoms, including sore gums and abscesses. Long standing gum disease can also lead to periodontal disease, which affects the tissue around the teeth. This is much more serious and can lead to tooth loss and damage to the jawbone if untreated.

The causes of gum disease are the same as tooth decay. It all comes down to damage caused by plaque build-up. Smoking can also make gum disease much worse as the lack of oxygen in the bloodstream caused by smoking slows down the recovery of the gums, and has been linked to higher levels of plaque. Fortunately, gum and periodontal disease are usually kept in check with a good level of oral hygiene. It is important to make sure that customers visiting the pharmacy for oral care products and advice are directed to brush their teeth twice daily, brushing all the way up to their gums, and flossing regularly. 

If customers are experiencing bleeding gums or are having more serious symptoms, they should be encouraged to visit their dentist, who can complete a more comprehensive check-up. Dentists can perform a thorough clean of the teeth, which may take several sessions, as well as providing additional, personalised advice for keeping the teeth and gums healthy.

Healthy mouth, healthy body

A 2019 study published in the journal Vascular Heath and Risk Management found that gum disease may double stroke risk. The researchers suggest this is due to changes in how blood and oxygen flow to the brain when gums are inflamed. This latest study supports previous studies that have linked a heightened stroke risk with gum disease, including some which noted that the risk of stroke increases as gum disease worsens. 

Similar links have been found for gum disease and numerous other conditions, including heart disease and diabetes. While there are many well-established factors that can affect all of these conditions, particularly smoking and diet, it is thought that gum disease is a little-known factor. Indeed, Dr Carter notes that only one in six people are aware of the link between gum disease and stroke. 

Recently, dental health organisations have been doubling down on their advice to play close attention to bleeding and inflamed gums, and to seek expert advice when necessary. Pharmacy teams can join the battle by highlighting the importance of dental hygiene, including flossing, as well as raising awareness of the more serious implications of gum disease.