Tooth decay
When you mention dental problems, most people probably think of having a cavity that needs to be filled by a dentist. While some assume that this is only an issue for children, tooth decay is in fact one of the most widespread health problems in the UK today, affecting 31 per cent of adults.
Overall, tooth decay has improved among children, with two in three children aged 12 being decay-free, compared to less than one in 10 in 1973. However, it remains a concern.
Tooth decay is caused by a substance called plaque, which forms due to the bacteria that naturally live in the mouth. These bacteria thrive on sugary food to form a sticky film (plaque) over the surface of the teeth and gums. Plaque is one of the main reasons why it is important to brush teeth regularly.
When we eat or drink foods that contain sugars or starches, the bacteria in the plaque produce acids that attack enamel. Over time, this acid can destroy the enamel on the surface of the tooth, which creates cavities. Left untreated, dental cavities, or caries, can destroy a tooth. The only way to prevent this damage from worsening is to have the cavity filled by a dentist.
In older people, tooth decay can develop in teeth that have already been filled. This is due to fillings weakening and fracturing around the edges over time. Bacteria can accumulate in these tiny cracks, producing acids that lead to further decay.
Preventing tooth decay
The good news is that tooth decay can be avoided by preventing plaque from accumulating. In order to do this, teeth should be brushed twice daily with a fluoride toothpaste and the spaces between the teeth should be flossed every day.
Rinsing with a mouthwash that contains fluoride (e.g. Listerine and Colgate Plax) can also help to remove bacteria from hard-to-reach areas, as well as from the tongue, gums and roof of the mouth. Children aged six and over should use a mouthwash formulated for their age (e.g. Aquafresh Big Teeth Mouth Wash and Listerine Smart Rinse).
Tooth decay can also be reduced by limiting the number of snacks eaten between meals, particularly sweet food; having regular dental check-ups to help identify problems before they progress; and chewing sugar-free gum after eating to stimulate saliva €“ one of the body's natural defences against the acid produced by the bacteria in plaque.
Reflective exercise
Sally, 62, says her teeth feel very sensitive, particularly when she eats or drinks anything cold. She currently uses an ordinary toothpaste, but is interested in trying one specially formulated for sensitive teeth.
What would you recommend?
Before recommending a product, ask Sally when she last had a dental check-up as she may be suffering from a loose filling, receding gums, gingivitis or tooth decay. Otherwise, sensitive teeth are increasingly common with age and a sensitive toothpaste alongside good oral hygiene is likely to be effective.
What if:
After visiting the dentist, Sally returns to the pharmacy. She has been told she has gingivitis and needs to floss daily. However, Sally is worried that this may make her gums bleed.
Flossing teeth every day is an effective way to manage gingivitis and can help prevent the development of periodontal disease. Show Sally your range of floss and interdental brushes. Ask which she would prefer to use. Advise Sally to be gentle when she flosses her teeth and check whether her dentist demonstrated the correct flossing technique.
Reiterate the importance of brushing teeth twice daily with a soft toothbrush. As brushing cannot reach all of the teeth's surfaces, a mouthwash containing chlorhexidine may also be necessary. Not only do these have an antiseptic action, but they also help to rinse out any food debris lodged between teeth. Regular use of chlorhexidine mouthwash can stain teeth, but this is usually temporary.
Advise Sally to brush her teeth before using the mouthwash to reduce staining. She should then rinse her mouth well with water as chlorhexidine can be deactivated by certain toothpaste ingredients. The mouthwash should be used twice daily, rinsing 10ml for one minute or according to the manufacturer's instructions.
What if:
Sally's dentist told her she has signs of decay and needs a filling. Sally is surprised that she needs a filling at the age of 62.
It is a common misconception that dental decay and fillings only affect children. Some adults need fillings because an old filling has broken and needs replacing. If an old filling cracks, bacteria can enter and cause further decay. Remind Sally of the need for good oral hygiene and the importance of replacing her toothbrush every three months. A healthy lifestyle is also important. Sugary snacks and drinks are best avoided between meals as this can contribute to the build up of plaque and increase the risk of tooth decay. Ask if Sally is a smoker. If she is, direct her to your range of NRT therapies and offer advice to help her quit.
What if:
Sally has a grandson, Harry, aged six months. He is teething and a tooth has appeared in his lower gum. Sally wants to know when his mum should start brushing his teeth. A baby's teeth should be brushed as soon as the first milk tooth appears. Harry's teeth should be brushed twice daily with a low-strength fluoride toothpaste. Children should be supervised while brushing their teeth up to the age of seven years to ensure they are using the correct technique and to minimise the risk of choking.