Daily Self-Care Can Aid in the Prevention, Treatment of Oral Health Issues

Establishing daily oral hygiene habits, including brushing teeth, flossing, and obtaining routine professional oral health care at least twice a year, is integral to maintaining overall health and can prevent or improve various oral health issues.

Tooth brush and floss | Image credit: Zimmytws - stock.adobe.com

An abundance of research has established the correlation between poor oral health and the manifestation or exacerbation of multiple chronic diseases, including an augmented risk of developing cardiovascular, metabolic, and autoimmune diseases.¹ Improper oral hygiene also contributes to an increased risk of developing dental caries, various degrees of periodontal disease (gingivitis and periodontitis), halitosis, and other dental-related issues, including edentulism (tooth loss) and denture-related discomfort.^1-4

The CDC indicates that poor oral hygiene and its manifestations may lead to an increased risk of infections, inflammation, and varying degrees of pain, which in turn may contribute to issues with eating and speaking, cause sleep disturbances due to pain or discomfort, and affect an individual’s self-esteem, social interactions, and overall productivity and quality of life.^4,5 The CDC also notes that the 3 oral conditions that significantly affect quality of life are cavities, severe gum disease, and severe edentulism.^4,5

In addition to poor oral hygiene, certain factors may increase an individual’s risk of developing periodontal disease and other oral health issues, including smoking or tobacco use, uncontrolled diabetes, immunocompromising conditions, poor nutrition, hormonal changes, and adverse effects associated with certain medications.² For example, some medications are associated with varying degrees of adverse dental effects, such as xerostomia, tooth discoloration, or abnormal bleeding or inflammation of the gum tissue.²

NEWS AND CLINICAL DATA

In the 2023 State of America’s Oral Health and Wellness Report, involving more than 2000 adults and parents of children 12 years and younger in the United States, researchers explored consumer opinions on oral health, and findings revealed generational variances among age groups concerning knowledge about oral care and habits.⁶

Key findings included the following⁶:

• An estimated 92% of adults and 96% of parents stated that oral health is very crucial to overall health; however, when queried whether sustaining good oral health enables a healthier lifestyle, 73% of Generation Z (Gen Z) reported that it does vs an average of 90% of millennials, Gen X, and baby boomers.
• When asked about eco-friendly or nontraditional dental products, 66% of Gen Z and 35% of baby boomers said they do use these products. One in 10 adults reported using eco-friendly oral care products such as bamboo or plant-based toothbrushes.
• An estimated 81% of respondents who maintained regular dental visits stated that they did not require unforeseen care, indicating that preventative care works.
• Saving money and avoiding dental issues such as cavities and gum disease were the primary reasons for practicing routine oral hygiene and dental care among 87% and 66% of respondents, respectively.

On June 26, 2023, the American Dental Association (ADA) issued the first-ever guidelines for treating tooth decay. The guidelines, published in The Journal of the American Dental Association, contain 16 recommendations and good practice statements. The panel of experts said available clinical evidence “suggests that conservative methods to treat tooth decay in primary and permanent teeth could lead to better outcomes when used with common restorative materials like fillings or caps.”⁷

In a recent publication of the International Journal of Environmental Research and Public Health, findings from a systematic review exploring the correlation between neuroinflammation in adults and periodontitis revealed that all studies provided clinical evidence of the correlation between periodontitis and cognitive impairment or dementia and Alzheimer disease (AD) pathology; however, the precise causes remain unknown, and more research is required.⁸

Additionally, in another study, published in Neurology and involving 172 participants, researchers discovered that periodontal disease and edentulism were linked with brain shrinkage in the hippocampus, which plays a role in memory and AD. However, the study authors indicated that this does not prove these are causative factors for AD and only demonstrates a correlation.⁹

“Tooth loss and gum disease, which is inflammation of the tissue around the teeth that can cause shrinkage of the gums and loosening of the teeth, are very common, so evaluating a potential link with dementia is incredibly important,” study author Satoshi Yamaguchi, PhD, DDS, of Tohoku University in Sendai, Japan, said in a press release. “Our study found that these conditions may play a role in the health of the brain area that controls thinking and memory, giving people another reason to take better care of their teeth.”

Finally, in a presentation at the American Heart Association’s International Stroke Conference 2023, preliminary research demonstrated that individuals who were genetically prone to cavities, missing teeth, or requiring dentures had a greater incidence of silent cerebrovascular disease, as represented by a 24% increase in the number of white-matter hyperintensities visible on MRI images.¹¹

“Poor oral health may cause declines in brain health, so we need to be extra careful with our oral hygiene because it has implications far beyond the mouth,” study author Cyprien Rivier, MD, MS, a postdoctoral fellow in neurology at Yale School of Medicine in New Haven, Connecticut, said in a press release. “However, this study is preliminary, and more evidence needs to be gathered—ideally through clinical trials—to confirm improving oral health in the population will lead to brain health benefits.”

The ADA notes the following key recommendations for oral health¹²:

• Brush teeth twice daily with an ADA-recommended fluoride toothpaste for 2 minutes and replace the toothbrush every 3 to 4 months.
• Floss at least once daily.
• Maintain a healthy, balanced diet with limited sugar intake.
• Seek routine dental care at least twice annually.

THE ROLE OF THE PHARMACIST

During counseling, pharmacists can remind patients that routine professional and daily at-home dental care can diminish or prevent many oral health issues. Through clinical interventions, pharmacists can be influential in identifying medications and/or medical conditions that may contribute to or exacerbate certain oral health issues, therefore obtaining valuable information that will enable them to make clinical recommendations tailored to patients’ individual needs.

Pharmacists can also assist patients in the selection of various OTC oral hygiene products on the market, including dentifrices, which include tooth powder and toothpaste and are used to clean and polish the teeth. They include formulations marketed for antiplaque, antigingivitic, tartar control, sensitive teeth, and whitening, as well as various flossing products, topical fluoride products, and cosmetic and therapeutic mouth rinses.

Because many medications cause xerostomia, pharmacists can also remind patients about the availability of oral care products formulated to target and prevent this issue. Various products, which encourage and aid in improving brushing techniques among children, are also available to meet the needs of the pediatric population. In addition to these products, an assortment of plaque-removal devices, such as manual and electric toothbrushes, dental flosses, and oral irrigating devices, can be used for removing plaque.

CONCLUSION

Through effective patient education initiatives, pharmacists can remind patients that although oral health issues are common, the majority of cases can be prevented with proper oral hygiene. Problems can also be effectively treated with early detection, prompt treatment, and recommended self-care measures.

About the Author

Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and medical writer in Haymarket, Virginia.

References

1. Zemedikun DT, Chandan JS, Raindi D, et al. Burden of chronic diseases associated with periodontal diseases: a retrospective cohort study using UK primary care data. BMJ Open. 2021;11(12):e048296. doi:10.1136/bmjopen-2020-048296
2. Melody K. Prevention of hygiene-related oral disorders. In: Krinsky D, Berardi RR, Ferreri SP, et al, eds. Handbook of Nonprescription Drugs. 20th ed. American Pharmacists Association; 2021:641-658.
3. Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim). 2017;11(2):72-80
4. Oral health fast facts. CDC. Updated January 25, 2021. Accessed June 27, 2023. https://www.cdc.gov/oralhealth/fast-facts/index.html
5. Adult oral health. CDC. Updated December 22, 2020. Accessed June 27, 2023. https://www.cdc.gov/oralhealth/basics/adult-oral-health/index.html
6. The 2023 State of America’s Oral Health and Wellness Report. Delta Dental. 2023. Accessed July 5, 2023. https://www.deltadental.com/us/en/state-of-americas-oral-health-report.html
7. Dhar V, Pilcher L, Fontana M, et al. Evidence-based clinical practice guideline on restorative treatments for caries lesions: a report from the American Dental Association. J Am Dent Assoc. 2023;154(7):551-566.e51. doi:10.1016/j.adaj.2023.04.011
8. Said-Sadier N, Sayegh B, Farah R, et al. Association between periodontal disease and cognitive impairment in adults. Int J Environ Res Public Health. 2023;20(6):4707. doi:10.3390/ijerph20064707
9. Yamaguchi S, Murakami T, Satoh M, et al. Associations of dental health with the progression of hippocampal atrophy in community-dwelling individuals: the Ohasama study. Neurology. Published online July 5, 2023. doi:10.1212/WNL.0000000000207579
10. Taking good care of your teeth may be good for your brain. News release. American Academy of Neurology. July 5, 2023. Accessed July 6, 2023. https://www.aan.com/PressRoom/Home/PressRelease/5097
11. Poor oral health may contribute to declines in brain health. News release. American Heart Association. February 2, 2023. Accessed July 6, 2023. https://newsroom.heart.org/news/poor-oral-health-may-contribute-to-declines-in-brain-health?preview=b6b1
12. Home oral care. American Dental Association. Updated December 30, 2022. Accessed July 6, 2023. https://www.ada.org/en/resources/research/science-and-research-institute/oral-health-topics/home-care