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Tackling oral care

Pharmacy teams are often the first point of call for customers suffering from oral problems. Sink your teeth into this roundup of common conditions and the advice you can provide.

As the coronavirus pandemic caused many dentists to close their doors, pharmacy teams have proven they can be a fantastic alternative for customers seeking oral care advice

Many people visiting a pharmacy are looking for pain relief and medication to rid themselves of toothache, mouth ulcers and other areas of discomfort in the mouth and jaw. To combat these, most pharmacies should stock a wide range of fluoride toothpastes, mouthwashes, brushes, floss and sugar-free chewing gum. 

"While dentists continue to tackle the backlog of patients caused by the pandemic, local pharmacy teams can play a role in advising customers on oral health matters," says Amanda Sheehan, dental hygienist and education and clinical support specialist at TePe. "They can give customers simple advice and share recommendations on products to use and the benefits each can provide."

Promoting good oral care

One in six people are likely to visit the pharmacy first to seek help for oral health issues, according to the Oral Health Foundation (OHF). For most customers, the steps needed to be taken to improve oral health are simple. Pharmacy teams have a vital role to play by reinforcing the information and supporting the education being given by dental practices. Key messages staff should highlight include: 

  • Brushing your teeth twice a day with toothpaste containing 1350-1500ppm fluoride, last thing at night before you go to bed and on one other occasion
  • Stopping smoking as this can stain teeth yellow, cause bad breath and increases risk of gum disease
  • Eating a healthy, balanced and low-sugar diet
  • Reducing alcohol intake as this can erode the outer surface of the teeth, leading to a loss of enamel. 

Customers will probably be aware that reducing sugar intake can go a long way in preventing tooth decay. Advice on how they can achieve this could include: 

  • Eating a balanced diet which includes plenty of fruit and vegetables as well as starchy foods such as bread, rice, potatoes and pasta
  • Sticking to one glass of fruit juice or smoothie a day, a person’s combined total of drinks from fruit juice, vegetable juice and smoothies shouldn’t be more than 150ml a day
  • Considering using sugar free medicines as sugar can unknowingly be found in many liquid forms of medication, particularly those used by children. Liquid medication that does not contain fructose, glucose or sucrose are described as 'sugar free'.

The importance of seeing a dentist

It is important that customers see the dentist regularly for check ups, even if there is nothing physically wrong with their teeth. For children, this means having an appointment every year, whilst adults can get away with every two years.

As they see patients more regularly and intimately than many other healthcare professionals, pharmacy teams are in prime position to put customers at ease and make them feel more confident with the idea of a dental visit.

"If a customer requests a product to treat a mouth ulcer, sensitive teeth or other 'strangeness' in their mouth, you could simply ask 'have you seen a dentist about this?'," says Miranda Steeples, dental hygienist, therapist and honorary treasurer of the British Society of Dental Hygiene and Therapy (BSDHT). 

"For customers asking for products to treat a dry mouth or oral thrush, advise them that a regular dental check-up would help to keep a watch-out and maybe even prevent these problems from occurring in the first place."

Conditions to watch out for

Toothache

Toothache is one of the most common reasons customers will come into the pharmacy for help with their oral care. Defined as a pain in or around the teeth, toothache can be caused by: 

  • Tooth decay
  • Dental abscess
  • Cracked/damaged teeth
  • Loose/broken filling
  • Infection
  • Problems with braces.

Customers may come into the pharmacy experiencing symptoms, such as:

  • A sharp, throbbing or constant pain in the teeth – for some people this will only be applicable when pressure is applied to the tooth
  • Swelling around the tooth
  • Fever or headache
  • Foul-tasting drainage from the infected tooth. 

Treatment for toothache varies depending on the severity but usually pharmacy teams can recommend painkillers such as ibuprofen, paracetamol or a pain-relieving gel. Eating soft foods such as yoghurt or scrambled eggs to avoid chewing with sore teeth or rinsing your mouth with salt water (should not be suggested for children) can also be recommended.  

Make sure to refer a customer to the dentist, not the GP as they are unable to provide dental treatment if the toothache: 

  • Lasts more than two days
  • Does not go away with painkillers
  • Comes alongside a high temperature
  • Causes pain when biting, red gums or a bad taste in the mouth
  • Causes the cheek or jaw to swell. 

Refer a patient directly to A&E if the area around the eyes or neck is swollen or if swelling in the mouth or neck is making it difficult for a customer to breathe, swallow or speak.  

Gum disease

Gum disease is caused by a build-up of plaque on the teeth. If you do not remove plaque from teeth by brushing and cleaning in between them regularly, it can build up and irritate the gums. Symptoms of gum disease include:

  • Gums bleeding when you brush your teeth, floss or eat hard foods such as apples
  • Gums becoming swollen, red and sore.

If left untreated, gum disease can lead to oral conditions such as bad breath or a bad taste in the mouth, gums shrinking or teeth becoming loose and falling out. Additionally, gum disease can be associated with wider health conditions. 

"Gum disease is one of the main causes of tooth loss in adults," says Dr Nigel Carter, chief executive of the OHF. "It is also increasingly being link to other general health conditions like heart disease, diabetes and some forms of dementia."

To avoid developing gum disease or if a customer is in the early stages, pharmacy teams can offer the following advice to their customers: 

  • Brush the teeth with fluoride toothpaste at least twice a day – spit after brushing, do not rinse
  • Clean in between the teeth every day using floss or interdental brushes
  • Replace toothbrushes every one to three months
  • See a dentist and dental hygienist for regular check-ups, especially if pregnant or have type 2 diabetes
  • Do not use mouthwash straight after brushing the teeth
  • Avoid smoking. 

If the gum disease has progressed and is more serious, for example a customer’s teeth are loose or they have red patches in their mouth, staff should refer them urgently to the dentist. Treatment at this stage can include: 

  • Deep cleaning under the gums
  • Antibiotics
  • Gum surgery. 

Mouth ulcers

Although rarely a sign of anything serious, of all oral health conditions, mouth ulcers are the most notably uncomfortable and painful, according to the OHF. Ulcers usually clear up in a week or two and need time to heal. Avoiding things that irritate the ulcer can help a patient to speed up the healing process and reduce any chance of it returning. 

"Often the cause of an ulcer is difficult to diagnose," says Ruth Giles, brand manager for Care at Thornton & Ross. "They can be caused by infection, allergy, or trauma such as brushing teeth too hard, biting the inside of the mouth or burning with hot food or drink. In some cases, there may be a genetic component and patients may describe a family history of mouth ulcers."

Pharmacy teams can offer customers lifestyle advice such as making sure to use a soft-bristled toothbrush, drink cool drinks through a straw, eat softer foods and a healthy, balanced diet. There are also many over the counter (OTC) treatments available to prevent ulcers and promote healthy gums. As Ruth explains: "Mouthwashes containing chlorhexidine are an effective product teams can reach for. Pharmacy staff can recommend these to customers for the maintenance of good oral hygiene, including helping to prevent gum disease, as well as for the treatment of ulcers."

Make sure to refer a patient to a dentist if their mouth ulcer:

  • Lasts longer than three weeks
  • Keeps coming back
  • Grows bigger than usual or is near the back of their throat
  • Bleeds or becomes more painful and red as this may be a sign of an infection.

Mouth cancer

Mouth cancer is when a tumour develops in a part of the mouth. It may be on the surface of the tongue, the inside or the cheeks, the roof of the mouth or the lips of the gums. Although globally, mouth cancer is the sixth most common cancer, in the UK it is much less widespread, accounting for one in every 50 cancers diagnosed. Squamous cell carcinoma is the most common form, making up approximately nine in every 10 cases. 

Symptoms of mouth cancer include: 

  • Mouth ulcers that are painful and do not heal within several weeks
  • Unexplained, persistent lumps in the mouth or the neck that do not go away
  • Unexplained loose teeth or sockets that do not heal after extractions
  • Unexplained, persistent numbness or an odd feeling on the lip or tongue
  • Sometimes, white or red patches on the lining of the mouth or tongue
  • Changes in speech, such as a lisp.

Customers are most at risk if they are over the age of 50, are male, drink excessive amounts of alcohol and smoke. Indeed, it is estimated that heavy drinkers and smokers have 38 times the increased risk of developing mouth cancer than people who neither drink nor smoke. 

If mouth cancer is diagnosed early, a complete cure is often possible in up to nine in 10 cases using surgery alone, according to the NHS. If a patient presents with any of these symptoms, pharmacy staff must make sure to refer them to the pharmacist for further consultation as soon as possible.  

Are you a green brusher?

When it comes to the environment, oral health has a far bigger role than we initially realise. In fact, 256 million toothbrushes are used and discarded in the UK every year, according to the Oral Health Foundation (OHF). The charity also found that it can take up to 400 years for a plastic toothbrush to degrade and if you laid out the toothbrushes thrown away in the UK in one year, they would wrap around the entire Earth. 

It’s not all bad news, however, as a 2021 study conducted by the charity in association with TePe, found that 80 per cent of UK adults reuse their old toothbrushes for other purposes. Of this number, 40 per cent used them to scrub their bathroom tiles, 26 per cent used them to add a glimmer to their jewellery and 18 per cent used them to shine their shoes. 

The OHF also offered a key top tip for pharmacy teams to give to customers aspiring to be "green" brushers: make sure to only have the tap running when rinsing your toothbrush. Turning the tap off when brushing can save up to 12 litres of water each time. Indeed, over the course of their lifetime, if the tap was left on whilst a family of four were brushing their teeth, they would waste more water than it takes to fill an Olympic swimming pool. 

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