Oral Care & Hygiene

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Oral Care & Hygiene

Introduction
 
Problems affecting the mouth are extremely common and although not usually serious they can cause your customers discomfort.  Your local Life Pharmacist is available to offer advice & support to customers on a variety of areas:
  • Oral hygiene
  • Gingivitis (gum disease)
  • Mouth ulcers
  • Oral thrush
  • Halitosis (bad breath) 
  • Dry mouth
Some of the above conditions can be prevented by good oral hygiene. This helps to avoid the build up of plaque on the teeth that can lead to tooth decay. Plaque is a soft whitish film that coats the teeth. It is a sticky mixture of bacteria and the substances that they secrete (mucopolysaccharides). Plaque builds up during the day where the tooth and gum meet, whether food is eaten or not. If you can feel a furry layer on your teeth with your tongue then this is likely to be plaque.
 
If teeth are not brushed regularly plaque is left on the teeth. This releases acid that can damage the tooth’s enamel. The acid dissolves the calcium in the teeth, forming small cavities. If not treated quickly these can get bigger. Eventually the acid destroys the softer dentine found in the inner layer of the enamel of the tooth. If left untreated, the pulp and the root of the tooth become decayed. This could lead to a dentist carrying out major work to save the tooth. In some instances this may not be possible and the tooth may have to be removed. 
 
 
Oral hygiene
 
Good oral hygiene is important in maintaining healthy teeth and gums. Customers can achieve this by following the four steps below:
  • Brushing teeth regularly 
  • Using fluoride
  • Using a mouthwash 
  • Cleaning between their teeth
Brushing teeth regularly
 
Teeth should be brushed at least twice a day, ideally after every meal. This removes plaque and prevents the build up of tartar (a form of hardened plaque) that can cause gum disease. Customers should follow the steps below to develop good oral hygiene:
  • Use a pea sized amount of toothpaste. This is particularly important for children as too much fluoride can damage the enamel 
  • Place the toothpaste on the head of the toothbrush
  • Angle the toothbrush at 45 degrees to the gum line and move the brush across the teeth in small circular movements
  • Clean one tooth at a time. Avoid pressing too hard as this can damage the gums
  • Gently brush the tongue a couple of times to remove bacteria and freshen breath
  • Brushing should take around two to three minutes, at least twice a day
 
Toothbrushes
 
There are many different types of toothbrushes available. Customers can buy soft, medium or hard bristle toothbrushes, different bristle angles, sizes and head shapes. Electric toothbrushes are effective in the removal of plaque. They are particularly useful for those who have a tendency to brush their teeth too hard and so might damage their gums. Customers who express concern about sensitive teeth should be advised to use a very soft textured brush.  It is recommended that toothbrushes should be changed every three months.
 
Toothpaste
 
Toothpaste should be used to promote oral hygiene. It works as an abrasive that removes plaque and food from teeth, helps suppress halitosis, whilst delivering active ingredients such as fluoride to prevent tooth decay. Brushing teeth also helps prevent gingivitis. Customers who express concern about sensitive teeth should choose toothpaste formulated to reduce this. 
 
Disclosing tablets
 
Disclosing tablets contain a special dye that stains plaque. They are particularly useful to help children develop good oral hygiene. One tablet should be crushed between the teeth and the liquid spread around the teeth and gums. Plaque will then be stained red. Any remaining liquid should be spat out and the mouth rinsed with water. Teeth can then be brushed, ensuring all red stain is removed (and therefore all plaque). Once effective brushing is learnt, disclosing tablets can be used after brushing to make sure all plaque is removed.   
 
Using fluoride
 
Fluoride strengthens the outer surface of the teeth to help prevent damage from the acid produced by the bacteria in plaque. It is particularly beneficial in young children when their teeth are developing. Some dentists recommend the use of fluoride drops or tablets where fluoride is not present in drinking water. They should only be sold if the customer has been recommended these by their dentist as too much fluoride can cause mottling (a health condition caused by a person receiving too much fluoride during tooth development) of the teeth. Fluoride is also contained within many toothpastes and mouthwashes, and so care should be taken not to swallow these. Customers with sensitive teeth can speak to their dentist and have a layer of fluoride ‘painted’ onto the sensitive areas to try and reduce this.   
 
Using a mouthwash
 
Mouthwashes help in a number of ways. They can be used to treat and prevent gingivitis as they contain antibacterial ingredients such as chlorhexidine or triclosan, help remove food particles and freshen breath. There are also some that contain fluoride to strengthen tooth enamel. 
 
Cleaning between teeth
 
Plaque can get between teeth where it is more difficult for toothbrushes to reach. There are a number of products that can help with this.
  • Dental floss
  • Dental tape
  • Interdental brushes
 
Dental floss
 
Dental floss comes in nylon or plastic ribbon. It is used to remove food and dental plaque from between teeth. The floss is gently inserted between the teeth and scraped along the teeth sides, especially close to the gums. Dental floss may be flavoured or unflavoured, waxed or unwaxed. There are many different kinds of dental floss available. The most important variable is thickness. If the floss is too thick for the space between teeth then it will be difficult or impossible to get it down between the teeth. On the other hand, if it is too thin, it may be too weak and break. Specialised plastic wands have been produced to hold floss. Ergonomic flossers with an improved handle for better grip and swiveling floss heads allow easy access to any teeth in the mouth. 
 
Dental tape
 
Dental tape is similar to floss but also has some important differences. It is wider, thicker and flatter and covers more surface area than floss. Whether a customer chooses floss or tape is purely down to personal choice and what works best for their teeth.
 
Interdental brushes
 
An interdental brush, also called an interproximal brush or a proxy brush, is a small brush, used for cleaning between teeth, around bridges, braces and dental implants. It is an alternative to dental floss and tape. Some people find interdental brushes easier to use than floss or tape and less time consuming.
 
There are a variety of brushes available with angled heads, differing lengths of handle and brush head. The brush head is either made from bristle or plastic covered metal wire, designed to avoid damage to dental implants. Customers should be advised to consult their dentist before choosing a brush to ensure they are using the right brush for their needs. Brushes should never be forced into spaces; the bristles should do the work by making contact with the teeth and gums to remove any plaque. There may be a need to use more than one size of brush as the spaces between teeth, bridges, braces and dental implants will vary.  Like dental floss or tape, the brush is inserted between the teeth to remove food and plaque and should be used on a daily basis to be effective.
 
Interdental brushes should be changed every week or when the bristles become worn. Brushes that have plastic covered metal wire can be damaged by undue force and continuous bending at sever angles, which is not recommended. If customers are complaining of using too many brushes, you should sensitively ask if they are using the brush correctly. If you believe they are not, you should recommend that they consult their dentist. Be careful in your questioning as your customer maybe sensitive about this area of their oral hygiene.
 
Dentures
 
Dentures (or false teeth) are removable replacement teeth that can either be complete (when all teeth are missing) or partial (when some teeth are missing). Good oral hygiene for denture wearers is also very important to ensure gums are looked after and prevents sore spots occurring. Dentures should be cleaned by soaking overnight using a denture cleaning liquid/dissolvable tablet or using a denture paste or powder. Denture brushes should be used to lightly brush them, with no pressure placed on the plate (a pink or gum coloured plastic base which holds the denture in place in the mouth). Vigorous brushing should be discouraged and the brush changed regularly to ensure the plate is not damaged, as this can also lead to sore spots on the gums and discomfort. Sore spots can be treated in a similar way to mouth ulcers. If symptoms persist or worsen, you should refer the customer to their dentist to check on the fit of their dentures. In order to hold dentures in place, fixatives are used. These are available as creams, cushions and strips. 
 
 
Gingivitis
 
Gingivitis is caused by a bacterial infection of the gums. It can progress to periodontal disease (when there is a possibility of the teeth falling out). According to the British Dental Health Foundation, 19 out of 20 people suffer from gum disease at some point in their lives. Having good oral hygiene can easily prevent gingivitis. Regular brushing will remove the daily build up of plaque as if it is not removed, it can build up and gradually harden to form tartar. Tartar can cause gingivitis. Tartar cannot be brushed off and has to be removed by a dentist or dental hygienist. There are various triggers that mean that certain people may be more at risk from gum disease than others. These are:
  • Genetics (the passing on of certain genes from parents)
  • Hormonal changes (such as puberty and pregnancy)
  • Stress 
  • Smoking
  • Grinding teeth
  • Some types of medication
  • Poor nutrition
  • People who suffer with diabetes
 
Symptoms
 
The symptoms of gingivitis are bleeding and sometimes swollen gums. Gums tend to be either deep red in colour or very pale. If left untreated, this can then lead to a receding gum line, bad breath and sensitivity around the teeth when eating or drinking hot or cold food or drinks. At worst it can lead to the bone supporting the teeth being destroyed and teeth being lost (periodontal disease).
 
Treatment
 
Dependent on the severity of the condition, gingivitis can be treated with regular visits to the dentist and by following good oral hygiene. Dentists or your Pharmacist may recommend a product for the treatment or prevention of gingivitis and these usually contain chlorhexidine. 
 
Mouth ulcers
 
Mouth ulcers can be caused by an injury to the cheek, biting the tongue or gum, burning or rubbing by dentures/braces, or by an unknown cause. They are not infectious. Some people are more prone to mouth ulcers, such as those:
  • Suffering from stress
  • With a vitamin deficiency
  • Undergoing radiation therapy
 
Some women may find a link between getting mouth ulcers and their menstrual cycle. Mouth ulcers are normally seen as white or yellow areas within the mouth. They may look swollen and red around the outside of the ulcer due to inflammation of the area.
 
Symptoms
 
Most mouth ulcers last between 10-14 days with the first five days being the most painful. Symptoms vary depending on the person and the length of time the ulcer has been present. They include:
  • Tingling, burning sensation and general sensitivity in the area
  • Pain when touched
  • Difficulty eating associated with the pain of the ulcer
Certain foods may increase the pain such as salty, acidic or spicy foods.
 
Treatment
 
Ulcers will heal over time. Symptoms can be alleviated by one of the following:
  • Local anaesthetics (benzocaine, lidocaine). These help numb the site of the pain and take the form of gels and pastilles which can be applied directly to the affected area 
  • Antiseptics (chlorhexidine). This tends to be in the form of a mouthwash. It kills bacteria to help reduce any infection (or possible infection)
  • Analgesics (choline salicylate). This helps relieve the pain and inflammation and has a mild antiseptic action. It is related to aspirin and so should not be used by customers who can’t take aspirin. This is in the form of a gel which can be applied directly to the affected area 
  • Protective agents (carbenoxolone). These stick to the soft tissue in the mouth, creating a barrier that allows the ulcer to heal 
Practical advice
  • When applying any product to the mouth, you should always wash your hands to ensure they don’t introduce any additional infection
  • The use of an antibacterial mouthwash during the time when ulcers are present will reduce bacteria. If you suffer with persistent ulcers they may want to consider adding this to your daily oral hygiene regimen
  • Avoid salty, acidic or spicy food 
 
Oral thrush
 
Oral thrush is a mild fungal infection of the mouth. It is caused by candida albicans. 
 
Symptoms
 
The symptoms are a sore and reddened tongue and throat with white plaques (white or creamy looking deposits or areas) on the inside of the mouth. Adults may also experience a discomfort or burning sensation in the mouth.
 
Treatment
 
Miconazole is an anti-fungal and comes in the form of a gel. It should be applied to the affected area following the instructions. It is flavoured with orange so that it tastes better.
 
Practical advice
  • When applying any product to the mouth, you should always wash their hands to ensure they don’t introduce any additional infection
  • Sometimes oral thrush can be caused by the use of inhalers that contain steroids. These are used by asthmatics to control their symptoms 
 
Halitosis
 
Halitosis or bad breath is a common complaint that can be due to a variety of causes: These include:
  • Bacteria on the teeth and gums (plaque)
  • Smoking
  • Food such as garlic and heavily spiced dishes 
  • Infections such as tonsillitis or catarrh 
  • Dry mouth (xerostomia) 
 
Symptoms
 
A good way to find out if you have bad breath is to lick the inside of your wrist and smell it. This will give an indication of what others can smell when you speak or are close to them.
 
Treatment
 
The best treatment is good oral hygiene and alter diet. Breath freshener sprays, lozenges and mouthwashes can also help.
 
Practical advice
 
Getting into a habit of good oral hygiene is key and keeping regular dental appointments (a regular check up, once a year is recommended)
 
 
Dry mouth
 
Dry mouth or xerostomia occurs when insufficient saliva is produced in the mouth. Saliva is produced to moisten and cleanse the mouth and start the digestive process. It also helps prevent infection by controlling bacteria and fungi in the mouth. Dry mouth can be very uncomfortable and can increase the risk of developing gingivitis and oral thrush.
 
It can be caused by:
  • Certain prescribed and non-prescribed drugs. These include some anti-depressive medicines, anxiety medicines, high blood pressure medicines, and medicines treating epilepsy and pain. The best way to check if this is a side effect of a medicine that you are taking, is to check the Patient information Leaflet that came with your medicine. The higher the listing, the more likely the symptoms will be felt
  • Certain medical treatments such as irradiation of the neck and head region for treatment of cancer can damage the salivary glands and so reduce the amount being produced
  • Certain diseases/medical conditions can cause the sufferer to have a dry mouth (such as diabetes, someone who has suffered a stroke, someone who has Alzheimer’s or Parkinson’s disease)
  • Dehydration
  • Smoking  
Symptoms
 
Common symptoms of dry mouth are:
  • Dry feeling in the mouth and throat
  • Sores in the mouth
  • Feeling thirsty all the time
  • Dry, red sore tongue
  • Halitosis
  • Difficulty speaking 
  • Loss of taste and difficulty swallowing
Treatment
 
Dry mouth can be treated with artificial saliva products. These come in the form of sprays, liquids and pastilles. They help to provide moisture, and so relieve the unpleasant symptoms of the condition. Dependent on the cause of the dry mouth, you may be prescribed products by their GP or consultant. If not, many are available to buy over the counter. 
 
Practical advice
  • Customers should be advised to try sucking a sugar free sweet or chewing sugar free gum to help stimulate the production of saliva
  • Frequent sips of a cool drink may help to keep the mouth moist
  • A room humidifier may be of use to regulate the humidity whilst sleeping
  • Good oral hygiene should be maintained to reduce the possibility of gingivitis 
  • Breathing through the nose and not the mouth will help to avoid the mouth from further drying out