In recent years, published reports and studies have resulted in newspaper headlines and more cautiously created articles, suggesting a firm connection between poor oral health and an increased risk of serious health conditions such as cardiovascular disease, stroke, Alzheimer’s disease and certain cancers.

One of the main oral health issues thought to increase the risk of such conditions is periodontitis. As a bacterial disease, if the associated bacterium reaches the bloodstream through bleeding gums, it is absorbed into the body’s vital organs, potentially leading to serious and sometimes fatal conditions. Additional problems can arise if a patient has ongoing health issues including pneumonia or other respiratory conditions, as the increase in bacteria in these areas can exacerbate the prevailing condition.

The challenge in convincing the general public of the connection between periodontal disease and chronic conditions, lies in the fact that many of the factors which contribute to the latter, are based on genetic and socio-economic reasons. The multifactorial nature of such diseases leads to confusion, in that there is no simple cause and effect correlation. However, the clinical evidence thus far is more than sufficient to warrant higher levels of patient education in the preventive measures that can be adopted to improve oral health.

Prevention
We often hear that prevention is better than cure, but prevention itself is a major part of the cure. Being part, of a systemic solution in maintaining good oral and, therefore, general health. This idea rests on the principle that if preventive methods are rigidly adhered to and patient self-care education made suitably available, then the mouth should remain healthy, a situation that will in turn support general health.

Controlling plaque to prevent oral disease
Because periodontal disease and caries are plaque-related infections, plaque removal and control is the most important measure in preventing caries, gingivitis and periodontitis. Controlling plaque levels can be achieved by using proper brushing and flossing techniques and visiting a hygienist and/or dentist regularly as prescribed. Incorporating a fluoride toothpaste or dentist-recommended mouthwash into a dental regimen will also help control plaque levels by inhibiting plaque metabolism.

By teaching patients to recognise certain symptoms, demonstrating effective brushing and flossing techniques, and encouraging them to keep dental appointments, the dentist and hygienist are communicating the problem as well as the solution to avoiding oral health issues. However, a recent UK survey revealed that only an average of 63% of adults visit their dentist regularly[1], making prevention education an uphill battle. With over 80% of the UK population having more than one filling and 31% having dental caries[2], spreading the word about prevention is imperative.

Educating to change perceptions
Good oral health has traditionally focussed on tooth and gum care as separate from the rest of the body, so associating bleeding gums with the risk of a heart attack, for instance, is an unfamiliar concept. As part of prevention education, the dental professional should emphasise that oral health conditions are not necessarily confined to the mouth, rather they could relate to other health issues elsewhere in the body. If the concept that the mouth and body work together – not separately – is to be accepted, a concerted effort must be made to educate patients.

Dental care professionals – particularly hygienists – are principally responsible for changing patients’ perceptions in terms of how prevention can act as a systemic solution to oral infections as well as more serious health problems. Therefore, it is vital to equip dental hygiene teams with the most effective tools and training to treat and educate patients about the importance of good oral hygiene.

Changing behaviours
It is well recognised amongst the profession that prevention of periodontal disease and the maintenance of periodontal tissues after treatment depend on patient motivation and ability, but taking these messages direct to the patient and underpinning the role they play in their own oral health is equally as important if behaviour is to change. Effective plaque control and removal are both essential to prevention, and taking an individualised approach to educating patients in this area is likely to have the greatest impact. To assure long-term success, the profession is challenged with changing patient behaviour in relation to cleaning, brushing and flossing, often adjusting years of routine. Advice may vary according to the health of the patient: for example, an elderly or less dextrous patient may be better advised to use an electric toothbrush rather than a manual one; smokers should be educated in smoking cessation; dietary changes may be advised where necessary, and so on. It is the role of the dentist, hygienist or dental therapist to encourage patients to change behaviours and to teach the required plaque removal skills using demonstrations. This is where ongoing support from the profession is crucial, to encourage behavioural adjustments over time.

Patient self-care responsibility
The responsibility for good oral health also falls to patients themselves who, in turn, should be passing on their education to others, especially children. In line with this, FGDP(UK) Dean Dr Mick Horton commented on a recent NHS digital report, saying:

It is clear that adults and children need to visit their dentist regularly to aid in the early detection of any problems and allow the Dental Care Team to give preventative advice and treatment where necessary. It is important that parents understand they have a responsibility to also improve the Dental Health of their children through regular dental appointments, good oral hygiene and following a low-sugar diet, recognising that together we can reduce the incidence of tooth decay.”[3]

Prevention’s part of a systemic solution
Whilst prevention in the form of maintaining good oral health does not provide the full solution to avoiding oral disease and, therefore, reducing the risk of serious health conditions, it certainly plays an important part in it. Of course established lifestyle, genetics and other factors play their part, but without prevention, the solution to reducing the risk of serious health conditions is incomplete.

[1] National Smile Month: http://www.nationalsmilemonth.org/facts-figures/
[2] ibid
[3] http://www.bsdht.org.uk/news-1/nhs-statistics-indicate-more-needs-to-be-done-to-improve-oral-health-says-fgdp-uk-1

Blair Morgan

Author Blair Morgan

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