CHAPTER 8 Oral Health Promotion
Oral health promotion involves educating people about how to achieve and maintain good oral health. A dental nurse should be able to provide competent and complete oral health promotion. This includes:
This chapter presents an overview of the oral health messages that you should know and should be able to educate patients about. It will describe the measures and oral health devices (dental care accessories) and materials and techniques that patients can use to achieve and maintain oral health.
Guidelines from the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Acute Care (NCAC) recommend the following general intervals between check-ups:
However, the interval between check-ups needs to be decided on a patient-by-patient basis. Each patient’s check-up routine should be based on their needs, their disease levels and their risk of developing dental disease. The guideline also recommends that during a check-up, the dental team should ensure that:
Most oral diseases, including not only the more common problems (such as tooth surface loss due to caries, trauma, abrasion, erosion and periodontal disease) but also potentially fatal diseases (such as cancer), are largely related to people’s lifestyle and habits (Table 8.1). Thus these diseases are often preventable by careful attention to lifestyle. For example, oral health can be improved by:
|Cancer||Tobacco, alcohol, betel nut use|
|Candidosis||Dry mouth, antibiotic use, HIV and other immunity problems|
|Caries||High sugar diet, low fluoride|
|Erosion||Soft drinks, fruit juices, alcohol|
|Halitosis||Plaque accumulation, tobacco use, alcohol use|
|Periodontitis||Plaque and calculus accumulation, tobacco use|
|Trauma||Alcohol use; some contact sports|
This chapter is based on the toolkit ‘Delivering better oral health: An evidence-based toolkit for prevention’ by the Department of Health and British Association for the Study of Community Dentistry. See the Department of Health website for the full toolkit (www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078742)
Refined carbohydrates and sugars, particularly non-milk extrinsic sugars in items other than fresh fruits and vegetables, are the major causes of dental caries (Chapter 5). The frequency of intake is more important than the amount. Thus to lessen the chances of accumulating dental plaque, and developing caries, it is important to limit and reduce the frequency of consumption of sugary foods, such as restricting them to meal times.
Breast-feeding is best for babies, and they should be weaned onto sugar-free foods. From 6 months of age infants should be introduced to drinking from a cup and from 1 year of age bottle-feeding should be discouraged. Drinks other than milk and water should not be given to pre-school children in feeding bottles, and should be given only at main meals. Foods should be free of or very low in sugars other than those in fresh milk and raw fruits or vegetables.
The National Pharmacy Association leaflet ‘sugar in medicines’, and the Delivering better oral health’ toolkit contain information about the sugar (fructose/glucose/sucrose) content of branded oral liquid medicines, both over-the-counter and prescription-only medicines. Products that do not contain these sugars are listed as being sugar-free. Preparations containing hydrogenated glucose syrup (Lycasin), maltitol, sorbitol or xylitol are also listed as sugar-free, since there is evidence that they are non-cariogenic.
Fluoride varnish is one of the best options for the application of topical fluoride to teeth. Fluoride varnish can also arrest existing caries (stop it spreading) on the smooth surfaces of deciduous teeth and roots of permanent teeth.
Prophylaxis: In the dental context prophylaxis refers to cleaning the surface of teeth with a rotary brush (see Figure 8.8 below) to remove all plaque and fine deposits before treatment.
There is a small risk of allergy to the colophony component of Duraphat. Therefore varnish application is contraindicated for children who have a history of allergies, including asthma. Duraphat is also contraindicated in patients with ulcerative gingivitis and stomatitis (see Chapter 5).
Fluoride mouthwashes or rinses can be prescribed for patients aged 8 years and above, for daily or weekly use, in addition to twice-daily brushing with toothpaste containing at least 1350 ppm fluoride. They should be used at a different time to toothbrushing to maximise the topical effect. Fluoride mouthwashes and gels are particularly recommended for people with a dry mouth (hyposalivation; see Chapter 5), who are otherwise particularly at risk of caries.