Peninsula Dental Social Enterprise (PDSE) Adult 16+ years Oral Health Promotion - individually tailored optimal daily oral care Version 3.0 Date approved: October 2016 Approved by: The Board Review due: October 2019 Policy will be updated as required in response to a change in national policy or evidence-based guideline. Page 1 of 15
2 Oral health advice given by dentists and dental care professionals Give all patients (or their parents or carers) advice during dental examinations based on the oral health messages in Public Health England's Delivering better oral health. This includes: advice on oral hygiene practices use of fluoride advice diet, smoking, smokeless tobacco alcohol intake. Ensure the advice is tailored to meet individual needs. Consider delivering oral health improvement messages in a variety of formats and using different media to meet the needs of different groups.
3 Dentists and dental care professionals should adopt a patient-centred approach Encourage the dental practice team to develop a good relationship with patients so they can help them maintain good oral health. All staff, including reception and support staff, should understand the importance of creating a welcoming environment for everyone. This includes: families with babies or very young children, children and adults with a physical or sensory impairment. Recognise that contact with those who do not attend regularly (for example, when they attend for emergency care) provides an important opportunity to establish a positive relationship Provide information about how people can find a local dentist or find out if they qualify for free or subsidised NHS dental care Listen to patients' needs and offer tailored advice, without judging them if their oral health is poor or if some of their behaviours adversely affect their health Create an individually tailored dental care plan with the patient or their parent or carer. This should combine strategies to prevent, as well as to treat, oral health problems. To develop the preventive part of the plan, ask about the patient's: personal circumstances and their oral health (in the past and now) to gauge their risk of poor oral health oral hygiene practices and how often they use fluoride behaviours that may affect their oral health in the short or long term, including their diet, smoking, or using smokeless tobacco or alcohol
4 existing health conditions or any disabilities or other difficulties that might prevent them from maintaining or improving their own oral health, or the oral health of someone they care for. ensure the patient, or their parent or carer, understands the plan to maintain or improve their oral health. Be aware of the personal, cultural, social, environmental and economic barriers to good oral health. This includes; the links between poor oral health and socioeconomic deprivation recognising that some people may not think it is important to go to the dentist regularly understanding that some parents or carers may not realise that it is important to keep children's primary teeth healthy being aware that people may need help to use dental services
5 Advice to be given for prevention and management of caries Adults Basic dental examination and appropriate BPE Dietary advice the frequency and amount of sugary food and drinks should be reduced. The WHO recommends no greater than four intakes of sugars per day All at high risk of caries; 3 day diet diary and investigation and assist with adoption of good dietary practice in line with the eatwell plate Adults Adults high risk Brush twice daily, with a fluoridated toothpaste, last thing at night and on one other occasion Use toothpaste containing at least 1,350 ppm fluoride As adjacent for adults PLUS; Use a daily mouthwash (0.05%NaF - ) at a different time to brushing Spit out after brushing and do not rinse
6 for prevention and management of caries Adults Basic dental examination and appropriate BPE Adults Adults high risk Apply fluoride varnish to teeth twice yearly (2.2% Fˉ) For those with active coronal or root caries prescribe daily fluoride rinse For those with obvious active coronal or root caries prescribe 2,800 or 5,000 ppm fluoride toothpaste
7 Prevention of periodontal disease, for all adults and children to be used in addition to caries prevention Self-care plaque removal Advice to be given Remove plaque effectively using methods shown by the dental team This will prevent gingivitis and reduces the risk of periodontal disease Daily, effective plaque removal is more important to periodontal health than tooth scaling and polishing by the clinical team Advise best methods of plaque removal to prevent gingivitis, achieve lowest risk of periodontitis and tooth loss. Use behaviour change methods with oral hygiene instruction Correct factors which impede effective plaque control including; supra- and subgingival calculus, open margins and restoration overhangs and contours which prevent effective plaque removal
8 Toothbrushing and toothpaste Advice to be given Brush gum line AND each tooth twice daily (before bed and at least on one other occasion). Use either Manual or powered toothbrush Small toothbrush head, medium texture With extensive inflammation start with toothbrushing advice, followed by interdental plaque control Assess patient s/parent/carer s preferences for plaque control Decide on manual or powered toothbrush Demonstrate methods and types of Brushes Assess plaque removal abilities and confidence with brush Patient sets target for toothbrushing for next visit Prevention of periodontal disease, for all adults and 12-17yrs to be used in addition to caries prevention Interdental plaque control Advice to be given Clean daily between the teeth to below the gum line before toothbrushing, For small spaces between teeth: use dental floss or tape For larger spaces: use interdental or single-tufted brushes Assess patient s preferences for interdental plaque control Decide on appropriate interdental kit Demonstrate methods and types of kit Assess plaque removal abilities and confidence with kit
9 Around orthodontic appliances and bridges: use kit suggested by the dental professional Patient sets target for interdental plaque control Periodontal risk factors Advice to be given Professional Intervention Tobacco Do not smoke Smoking increases the risk of periodontal disease, reduces benefits of treatment and increases the Ask, Advise, Act: take a history of tobacco use, give brief advice to users to quit and sign post to local stop smoking service chance of losing teeth Diabetes Patients with diabetes should try to maintain good For patients with diabetes: diabetes control as they are Explain risk related to diabetes At greater risk of developing serious periodontal disease Less likely to benefit from periodontal treatment if the diabetes is not well controlled Medications Some medications can affect gingival health For patients who use medications that cause dry mouth or gingival enlargement Explain oral health findings and risk related to medication Assess and discuss clinical management
10 Prevention of peri-implant disease Advice to be given Dental implants require the same level of oral hygiene and maintenance as natural teeth Clean between and around implants using an interdental kit and toothbrush Attend for regular checks of the health of the gums and bone around the implant Advise best methods for self-care plaque control, both for toothbrushing and interdental cleaning Prevention of Oral Cancer For all adolescents and adults Do not smoke Advice Do not use smokeless tobacco (eg paan, chewing tobacco, gutkha) Reduce alcohol intake to moderate (recommended) levels Increase intake of non-starchy vegetables and fruit Ask, Advice, Act Tobacco use very brief advice (see later) - Take a history of tobacco use, give brief advice to users and signpost to local stop smoking service Ask, Advice, Act Alcohol use very brief advice (see later) - Establish if the patient is drinking above low risk (recommended levels. If appropriate signpost to GP or local alcohol misuse support services if available.
11 Tobacco and Alcohol All adolescents and adults Advice and intervention about smoking and other tobacco use Advice Tobacco use, both smoking and chewing tobacco seriously affects general and oral health. The most significant effect on the mouth is oral cancers and pre-cancers. Do not smoke or use shisha pipes Do not use smokeless tobacco (e.g. paan, chewing tobacco, gutkha) If the patient is not ready or willing to stop they may wish to consider reducing how much they smoke using licensed nicotine containing product to help reduce smoking. The health benefits to reducing are unclear but these who use these are more like to stop smoking in the future. Ask, Advise, Act Ask- establish and record smoking status Advise- advise on benefits of stopping and the evidence shows the best way is a combination of support and treatment Act- offer help referring to local stop smoking services
12 Advice and intervention about alcohol Advice Drinking alcohol above the recommended levels adversely affects general health with the most significant oral health impact being increased risk of oral cancer. Reduce alcohol intake to low risk (recommended) levels Recommended Levels (May 2014) Men should not regularly consume more than 3-4 units per day Women should not regularly consume more than 2-3 units per day All drinkers should avoid alcohol for 2 days following a heavy drinking seession to allow te body to recover Pregnant women or women trying to conceive should avoid alcohol, but if they should choose to drink they should limit this to no more than 1-2 units once or twice a week and avoid getting drunk What is a unit of alcohol? Ask, Advise, Act Ask- establish and record if the patient is drinking above low risk (recommended) levels Advise- offer brief advice to those drinking above recommended levels Act- refer or signpost high risk drinkers to their GP or local alcohol support services One unit of alcohol is 10ml (1cl) by volume or 8g by weight of pure alcohol. This is equivalent to: half a pint of ordinary strength beer, lager or cider (3-4% alcohol by volume) a small pub measure (25ml) of spirits (40% alcohol by volume) a standard pub measure (50ml) of fortified wine such as sherry or port (20% alcohol by volume) half a glass (87.5ml) of wine (12% by volume)
13 AUDIT (C): Alcohol use disorder identification test Score Y 1 2 3 4 score Questions Score 0 Score 1 Score 2 Score 3 Score 4 Your score How often do you have a drink containing alcohol? Never Monthly or less 2-4 times per month 2-3 times per week 4+ times per week How many units of alcohol do you drink on a typical day when you are drinking? How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? 1-2 q3-4 5-6 7-9 10+ Never Less than monthly Monthly Weekly Daily or almost daily
14 Once a total score has been established the following advice should be given: Patients with a total score of 0-4 feedback that the patient is at a lower risk of harm from alcohol give advice on the safe limits encourage and congratulate them Patients with a total score of 5-9 feedback that the patient is at increasing or higher risk from alcohol related problems give advice on the safe limits encourage them to think about their drinking and benefits of cutting down, eg,reduced risk of: o oral cancer o dental and facial injury o tooth surface loss and periodontal disease o physical and mental health problems Give a leaflet and list of local services if available Patients with a total score of 10 plus If the patient has a score of 10 or more they should be given the brief advice as above but the importance of referral to their GP or a local alcohol support service stressed.
15 Advice and professional intervention about healthier eating Advice The frequency and amount of consumption of sugars should be reduced Avoid sugar containing foods and drinks at bedtime when saliva flow is reduced and buffering capacity is lost To aid dietary modification advice consider using a diet diary over 3 days, one weekend day and 2 week days