A closer look at teeth and gums
Babies are not usually born with any visible teeth, but that changes at around four to six months of age, when the teeth begin to push through the gums. Infants go on to develop 20 primary teeth €“ also called milk teeth or baby teeth. These are replaced later by 32 permanent teeth that last for the rest of our lives. Teeth are a little bit like trees €“ there is the visible part above the surface of the gumline (this is called the 'crown') and there is also an important root system which extends into the gums and down into the jawbone.
Teeth have a number of layers. The outer layer is an extremely hard material called enamel and inside the enamel is the dentine layer, which is a softer tissue. At the centre of the tooth is the pulp, and this is the area that contains blood vessels and nerves. Our teeth are surrounded by our gums (gingiva). The gums lie over the bones of the jaw and fit snugly around the neck of the teeth. Beneath the surface of the gums is a system of ligaments that anchor the teeth into sockets in the jawbone. In order to have good oral health, teeth need to be kept clean and free from decay. Gums also need to be healthy. However, there are a number of different conditions that may affect a person's teeth and gums.
Reflective exercise
Jane, 42, tells you that her gums bleed slightly when she brushes her teeth and asks if there is something that can help.
What would you recommend?
It sounds as if Jane has gum disease, which is a very common oral health problem. If not addressed, it can develop into a more serious condition known as periodontitis. Ask Jane when she last went to the dentist as she may benefit from a dental clean and check-up. In the meantime, gently reinforce the importance of good oral hygiene, with regular, twice-a-day tooth brushing with a soft bristled brush and a fluoride toothpaste. Check that Jane is changing her toothbrush every three months. Cleaning between the teeth is also important. Floss (waxed or unwaxed), dental tape or interdental toothbrushes can be used. A mouthwash containing chlorhexidine may also be recommended to improve gum health. Not only do these have an antiseptic effect, but they also help to rinse out any food debris lodged between the teeth. Regular use of chlorhexidine mouthwash can stain the teeth brown, but this effect is not usually permanent and brushing the teeth before using the mouthwash can reduce staining. The mouth should be well rinsed with water after brushing as chlorhexidine can be deactivated by some toothpaste ingredients.
What if:
Jane also says that her teeth are very sensitive, which is putting her off brushing her teeth. This would confirm your advice to Jane to have a check-up at the dentist. Her gum disease might be causing exposure of the roots of her teeth, which could result in sensitivity. Jane could also benefit from using a toothpaste and a mouthwash for sensitive teeth. Abrasive toothpaste and vigorous brushing should be avoided.
What if:
Jane tells you she is worried about her son's teeth. Tom is 10 and has some signs of tooth decay. Jane says he drinks fruit juice, which she thought was a healthy drink to give him, but the dentist has said he shouldn't have it very often. Jane is confused. Fruit juice contains sugar and is also quite acidic, so it can increase the risk of tooth decay. Fruit juice is best drunk at meal times, with food. To reduce the risk of tooth decay, it is best for Tom to limit the frequency of all sugary foods and drinks between meals. Frequency is crucial as it is the number of times the teeth are exposed to sugar that is important. Rinsing with a mouthwash containing fluoride is also a good idea. Advise Jane on a mouthwash suitable for a 10-year-old.
What if:
Chris Rowland, a man in his early 50s, asks you to recommend something for bad breath. €My girlfriend has mentioned it,€ he says, adding that he is just getting over a sinus infection. Chris's bad breath could be the result of his recent sinus problem. Also, if he hasn't been feeling too well, he might not have been managing his oral care as efficiently as usual. You might like to check on his oral care routine, but this will require sensitive communication skills on your part. A specialist mouthwash for bad breath could also be helpful while Chris's problem resolves.
What if:
Chris comes back to the pharmacy a month later and says that his bad breath has not resolved. In this case, you should refer Chris to the pharmacist as his problem could be a sign of an underlying condition.