Suggested Learning

The root of the problem

Gum disease is common among adults, but it’s not widely known that it is associated with other serious health problems. There's much pharmacy staff can do to help customers prevent and cure it

The connection between our oral health and overall health is well documented, yet many people don’t know that gum disease is linked to serious health problems. In fact, only one in six people realise that those with gum disease may have an increased risk of stroke or diabetes, and only one in three people are aware of the link to heart disease.

What is gum disease?

Gum disease, known as gingivitis, is inflammation of the gums surrounding the teeth caused by a build-up of plaque – the bacteria that form on the surface of teeth every day. The gums can appear red and swollen and a common first sign is bleeding when a person brushes their teeth or eats. Long-standing gingivitis can progress to periodontal disease, which affects the bone holding the teeth in place and can eventually lead to the teeth becoming loose.

Although many people can suffer gum inflammation and bleeding from time to time, around 10 per cent of the UK population experience this more aggressive form of the disease which, if allowed to continue, can cause serious problems such as tooth loss.

Health connections

Aside from leading to tooth loss, numerous studies over the past decade have shown that there is a direct link between periodontal disease and the onset of severe systemic disorders such as diabetes, cardiovascular disease, osteoporosis, Alzheimer’s, rheumatoid arthritis and cancer.

There has also been much debate regarding the cause of these links. Steve Williams, clinical services director at mydentist – one of Europe's largest dental care providers – explains that although a correlation has been determined, it’s the way an individual’s immune system responds to plaque that links oral health with other diseases. Therefore, since everyone is different, finding a definitive cause is difficult.

”The most recent studies have shown that it is the individual’s response (immune reaction) to the plaque which causes the inflammatory process that is important, and this will vary by individual. The inflammatory response in the gums is circulated around the blood stream and although this will not usually cause systemic disease, studies have shown there is a direct correlation between long-standing gum disease and systemic diseases.”

It is therefore unsurprising that improving gum health has been shown to reduce the risk of inflammatory substances in the blood stream and thus reduce the risk of chronic disease getting worse.

Prevention and cure

There is much that customers can do to prevent gum disease, according to dentist Dr Richard Marques, who says: “Number one is to stop smoking. Smoking is the worst thing for the gums. Good tooth brushing is also vital to remove the bacteria.” He recommends an electric toothbrush and interdental cleaning (between teeth) as the next important step in gum health. “Flossing, using interdental brushes or an electric water flosser, is important to remove bacteria between the teeth, which can affect the gums,” he says.

Dr Marques adds that mouthwash is also a good idea, suggesting: “The most natural remedy for gums is warm salt water. This is a teaspoon of salt in a cup of warm water three times daily (particularly after food), and mouthwash is effective for gum problems.” He also points out that if a customer has diabetes then “this must be under control or it can affect the gums in a negative way” – something which community pharmacy teams are ideally placed to pick up on and advise customers about.

Unfortunately, when it comes to curing gum disease, the options are limited and often painful. Dr Francesco Martelli, clinician, researcher and founder of the IMI Clinic, says: “Current treatment for the condition can include antibiotics, invasive surgery or tooth extraction. However, this is ineffective in eliminating the disease as periodontal bacteria live below the gum line, deep in the root where there is no blood supply. Antibiotics only kill some bacteria in the pockets, but they cannot penetrate the biofilm and reach the tooth dentine, where most bacteria live.”

In that respect, he stresses that prevention is better than cure, starting with “regular check-ups with the dentist and hygienist, brushing teeth twice a day and flossing regularly to ensure plaque is sufficiently removed from the teeth.”

Fashions and fads

As in so many areas of health, there are trends in dental care and it’s worth keeping up to date with these so that you can answer any questions that your customers might have.

For example, ‘oil pulling’ is a recent fad that has become more popular in the UK for teeth whitening and oral care. This involves swishing a tablespoon of oil (typically coconut, olive or sesame oil) in the mouth on an empty stomach for 10 to 20 minutes. Devotees say bacteria hiding under crevices in the gums and within the teeth are sucked out of their hiding places and held in the solution which is then spat out. However, Dr Francesco Martelli says there’s very little evidence to show that this is a successful method for teeth whitening. You should also explain that it cannot reverse the effects of tooth decay.

Cosmetic dental treatments such as tooth whitening are on the rise as people become more image conscious and are aware of the treatments that are available, and while whitening is not necessary, it remains a popular trend. For customers concerned about the colour of their teeth, an easy way to start is with a whitening toothpaste, although as Steve Williams, clinical services director, mydentist says: “The concentration of the active ingredients is low and the effect is minimal.”

Instead, he advises that if patients are serious about whitening their teeth, they should seek advice and visit their dentist to assess whether they are suitable. ”The process is easy and the dentist will take a mould of the teeth and produce a gumshield that fits the individual patient. The patient will then place the whitening gel inside the gumshield and wear for a few hours in the evening over a two-week period.”

Steve adds that "there are strict guidelines on the maximum concentration of whitening gel, which has been reduced recently, and there are very few side effects. Occasionally teeth can become sensitive during treatment, but this is usually reversible. It is illegal for anyone who is not a dental professional to provide whitening treatment, so buying whitening kits on the internet should be avoided at all times as the materials used could potentially be unlicensed.”

Regular check-ups

Many people only visit the dentist when they have a problem with their teeth, so you may want to explain to your customers why it is a good idea to have regular appointments with a dentist, and perhaps even a hygienist.

“It is important that patients visit their dentist regularly as they will be able check on how well they are looking after their teeth and give advice, which can change throughout a patient’s lifetime,” says Steve. “For example, some people may be unaware that they have any problems with their gums and still have aggressive forms of periodontal disease that may require early treatment to slow the progression.”

Face the fear

Dental phobia is very common and is one of the reasons why many people who need treatment don’t seek it, so you might have some persuading and reassuring to do. Dr Marques says that the best way to overcome dental phobia is to confront it, adding: “There are many dentists who have a special interest in treating nervous patients. Calming techniques can be used, so for example we have headphones with relaxing music to block out loud sounds. We also offer sedation and work with acupuncturists and hypnosis to help the patient overcome their fear. The single most important thing is finding a gentle dentist who can build a relationship of trust with you.”

Dr Martelli points out: “More often than not, people are scared of the dentist because they think treatment hasn’t changed over the past 20 years, but technology is very different nowadays.” He suggests that pharmacy staff “should advise that dentists are there to help prevent and treat disease, and have the patient’s best interests at heart. It also helps if the patient tells their dentist that they’re worried so that they can accommodate them accordingly by taking time to listen to the patient, put them at ease, and alleviate their fears by explaining the treatment plan, why it’s necessary and the process that’s about to unfold”.

Home care

For all patients, encouraging good at-home dental care is the main way they can keep their teeth and gums healthy, as Dr Marques explains: “A hygienist or dentist can clean teeth, but we rely on the patient to keep bacteria away from gums. A hygienist may see a patient every three months, but bacteria (plaque) must be cleaned daily at home, which is why at-home care is absolutely essential.”

There is much that you can do to advise customers about getting into good dental routines, and the kinds of products that can help. According to Soha Dattani, area medical director, GSK Consumer Healthcare, Northern Europe: “Pharmacy staff can play an active role in encouraging a good dental regime by advising shoppers on the importance of brushing twice daily and being aware of the symptoms of oral health problems, such as gum disease. It is vital that consumers are aware of the symptoms of gum disease and act on them as early as possible.”

Food for thought

There is another important factor when it comes to dental health and gum disease that is often overlooked in these days of electronic supersonic brushes, whitening, remineralising toothpastes and antibacterial plaque-destroying mouthwashes – and that’s food.

Our modern diets are problematic for the gums due to the high content of refined sugar – particularly in convenience foods and ready meals – and our habit of snacking on sugary foods and drinks in between meals. “Everybody needs sugar in moderation”, says Dr Marques, “but we must try and reduce this in our diets for the health of our gums, teeth and body. Bacteria feed on sugar, so reducing this will help the gums.”

One simple way that people can try to lower their sugar intake is to make a conscious effort not to add sugar to tea or coffee, and Steve advises that people should “always check food labels to identify sugar content. Processed and ready meals will contain higher levels of sugar, and drinks can also contain high levels, especially fizzy drinks, isotonic drinks and also fruit juices”.

Dr Martelli says pharmacy staff can advise customers that it’s important to drink water in between meals “as this helps to lower the attack of sugar on the teeth and gives the mouth time to neutralise.” He suggests reducing sugar intake “to a maximum of four times a day is key, and remember that some breakfast cereals can be sugary”.

Having all this knowledge to hand when you are talking to your customers about oral health and gum disease, as well as knowing the right products, techniques and professional to refer them to, could help them keep their teeth and gums healthier for longer. Now that’s something to smile about.

Encouraging good at-home dental care is the main way they can keep their teeth and gums healthy

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