Bite-sized advice

Aches and pains

Oral pain and toothache are common complaints seen in pharmacies, most commonly caused by tooth decay, gum disease, dental abscesses, and tooth damage. Other causes can include sensitivity from worn enamel, impacted wisdom teeth or infections, all of which irritate or inflame the sensitive nerves inside the tooth or gums.

Reshma says there are many solutions that pharmacy teams can offer customers suffering from oral pain: “Using a cold compress externally can reduce swelling, and oral analgesics such as paracetamol or ibuprofen can help. Topical local anaesthetic oral gels containing benzocaine can be recommended for temporary relief and even traditional natural remedies such as clove oil can be used to relieve toothache, but always ensure customers know to see a dentist if the pain persists for more than 48 hours or is getting worse.”

Gummed up

Gum disease is caused when plaque builds up on teeth and irritates the gums. Although a trip to the dental hygienist is a comprehensive – and often expensive – way to remove plaque, there is lots of advice that pharmacy teams can give customers to help them avoid the build-up in the first place.

“Brushing teeth and cleaning between teeth with floss or an interdental brush twice daily will help reduce build-up of plaque,” says Reshma. “It’s important to brush teeth with a fluoride toothpaste and spit, rather than rinsing the mouth with water or using a mouthwash straight after brushing, as that will wash away the toothpaste. You can also remind customers to replace toothbrushes at least every three months and book a dental check-up at least every one to two years – and yearly for under 18s and people who are pregnant or have type 2 diabetes.”

Smoking cigarettes and using other tobacco products poses a major risk to oral health through oral cancers, but also by damaging gum health, so signposting to smoking cessation advice is also important.

Unwanted ulcers

The most common causes of mouth ulcers include minor injuries from accidentally biting the inside of the mouth, irritation from braces or sharp teeth, and sensitivity to certain foods like citrus or spicy dishes. Other triggers can include stress, hormonal changes, vitamin deficiencies, or underlying health conditions such as gastrointestinal diseases.

Ulcers should heal on their own in a couple of weeks, but in the meantime, Reshma suggests a number of ways to cope with the discomfort: “Avoiding foods that irritate the mouth ulcer such as spicy, salty, acidic foods and hot drinks will speed up the healing process, reduce the pain and reduce the chance of it reappearing,” she says. “Using a soft-bristled toothbrush may decrease the irritation. Getting a regular check-up may identify the root causes, and it can help to eat a healthy, balanced diet and manage stress through exercise and relaxation techniques to prevent mouth ulcers.”

Reshma also recommends “protective pastes or gels to soothe and protect the ulcer along with antiseptic mouthwashes containing chlorhexidine or hydrogen peroxide-based to rinse the mouth.

“Topical pain relief containing anaesthetics like lidocaine and even using warm salt water as a mouthwash can help” when treating mouth ulcers.

The Oral Health Foundation (OHF) advises that any ulcer that lasts longer than three weeks should be looked at by a dentist, with an OHF spokesperson adding that: “This may be nothing at all, but a mouth ulcer that does not go away after this period may be a sign of mouth cancer. Similarly, other changes in the mouth that do not go away within three weeks, such as red or white patches, any lumps or anything different in the mouth or on the tongue, should be looked at by a dentist or GP to determine if a further referral is necessary.”

Sensitive solutions

Tooth sensitivity can be very uncomfortable and indicate first signs of tooth decay, often caused by high sugar diets and not cleaning teeth and gums properly and regularly.

A good tooth-brushing routine is the best way to keep teeth and gums clean and healthy, and pharmacy teams can recommend high-fluoride toothpaste, or toothpastes formulated for customers with sensitive teeth.

“Fluoride is a vital ingredient in toothpastes as it helps to strengthen and protect the enamel on our teeth, reducing tooth decay for both adults and children,” explains an OHF spokesperson.

All children up to three years old should use a smear of toothpaste with a fluoride level of at least 1,000ppm (parts per million). Children above three should use a pea-sized amount of toothpaste that contains 1,350ppm to 1,500ppm fluoride. Brushing teeth for two minutes and cleaning between teeth with a floss or interdental brush twice daily will protect against tooth decay and other oral health problems.

Once again, there is plenty of advice that pharmacy teams can give to customers about defending their teeth against decay. “As well as reducing general sugar intake and acidic drinks/snacks, you can also suggest customers choose sugar-free medicines where possible”, says Reshma, “and ask if those who smoke would like support and advice about quitting. Remind them to see their dentist if any symptoms don’t improve, as dentists may be able to reverse early tooth decay or fill if there is a cavity in the tooth, to avoid tooth decay reaching the soft tissue”.

Other oral health products such as mouthwash and interdental cleaning products should also be recommended for adults to complete a good oral hygiene routine at home. If customers are unsure about exactly what to choose, the OHF runs an independent accreditation programme evaluating oral health products to ensure that the claims made by manufacturers are clinically proven, giving the consumer added assurance and confidence. This currently covers more than 150 ‘approved’ products on sale all over the world, which come with a ‘smiley’ logo on those it recommends.

Joined-up working

Pharmacy teams and dentists both play key roles in supporting community health. When they collaborate effectively, they can provide more holistic, joined-up care for customers.

“Pharmacy teams are ideally placed to support patients and customers with oral health concerns in their local communities, as well as referring people to dentists for both emergency and routine care,” says Ingrid Perry MBE, prevention lead at dental care provider Mydentist.

“We also know from various studies that pharmacy staff express a strong interest in promoting better oral healthcare within their communities and often engage with local and national oral health campaigns such as Mouth Cancer Action Month or National Smile Month,” adds Ingrid, who says the best connections between community pharmacies and dentists work both ways.

“For example, some of our practices are taking part in cardiovascular case finding pilots, where patients can be referred to the local pharmacy for daily blood pressure monitoring, if the readings taken in practice are beyond the programme threshold and may indicate the patient has undiagnosed hypertension.

“Working in partnership with local pharmacy teams and sharing good practice enables us to ‘put the mouth back into the body’. This collaborative work helps us to take a holistic approach to healthcare rather than oral care being seen as an element of healthcare in isolation.”

By encouraging good oral care habits and offering clear, practical advice, pharmacy teams can make a real difference to customers’ long-term dental health and build their oral care confidence.