Maintaining Oral Health Is Essential to Well-Being

Maintaining oral health is essential to general health and well-being.¹ Oral conditions affect more than just the mouth and teeth. Poor oral health increases the risk of developing chronic conditions, such as cardiovascular disease and diabetes.²

The most common oral health problems include dental caries (tooth decay), periodontal disease (gum disease), and tooth loss. In the United States, more than one-fourth of adults have untreated tooth decay, and nearly half who are 30 years or older show signs of periodontal disease, which can lead to tooth loss if left untreated.³ Additionally, poor oral health can cause bad breath, dehydration, erosion of self-esteem, malnutrition, speech problems, and trouble eating and swallowing.⁴

Sugar → Acid = Trouble!

Dental caries develops when bacteria in the mouth metabolize sugars and produce acid that demineralizes the tooth’s hard tissues, causing a breakdown of the surface. Initial stages may be symptomless, but disease progression is associated with dark spots, toothache, and tooth sensitivity. Periodontal disease develops because of bacteria in dental plaque. The immune system attempts to eliminate the bacteria by releasing inflammatory substances, resulting in bleeding, swollen gums.⁵

Why Give Advice?

Acidic and sugary foods, poor oral hygiene, certain medications, and tobacco use can contribute to the development and progression of oral diseases. Pharmacists can help patients incorporate good oral hygiene practices into their routines, such as properly brushing their teeth twice daily with a fluoride toothpaste, flossing daily, and replacing toothbrushes at least every 3 months.⁵ Rinsing with a mouthwash can provide additional benefit, but it should not replace optimal brushing and flossing.⁶ Many OTC oral care products are available to meet patients’ needs (Table 1⁷). Additionally, both manual and powered toothbrushes are effective with proper technique, but individuals with limited dexterity may find it easier to use powered toothbrushes.⁸

When applied topically and ingested systemically, fluoride prevents tooth decay. Water naturally contains fluoride but at levels too low for dental benefit. Many communities fluoridate their drinking water, which is a highly effective practice. Individuals should contact their water utility provider to determine local fluoride levels.⁹

Those without fluoridated water should talk to their doctor about taking systemic fluoride supplementation, including oral lozenges and tablets.¹⁰

Diet and Habits Matter

In terms of diet, pharmacists should reinforce healthy eating habits, such as limiting acidic and sugary beverages and foods, which are the main culprit
behind tooth decay and erosion. Sugar may hide in several liquid medications, so it is imperative to read the label and suggest sugar-free alternatives if possible.¹¹ For example, patients could easily swap Robitussin Cough and Chest Congestion DM, which contains 2.3 g of sugar per 5 mL, 12 with its sugar-free alternative.

Smoking cessation is another area for pharmacist intervention. Smoking cessation decreases the risk of oral cancers, periodontal disease, poor oral wound healing, and premature tooth loss.⁵

Don't Forget Medications

Some OTC and prescription medications have unintended adverse effects (AEs) that affect oral health. The most common medication-induced oral condition is xerostomia (dry mouth), and more than 400 medications are known to cause dry mouth (Table 2^4,13,14). Insufficient saliva secretion dries the oral tissues and reduces buffering capacity, which alters normal flora. This leads to an array of problems, including increased susceptibility to infection, tooth decay, and trouble chewing and swallowing.

Medication-induced dry mouth is often reversible. Pharmacists can recommend discontinuing the offending agent and switching to one with less potential to cause dry mouth.¹³ Furthermore, pharmacists can advise patients to chew sugar-free gum or suck on sugar-free candies to promote saliva flow, frequently sip water, and limit intake of alcohol, caffeinated beverages, and tobacco.¹⁵

Other medication-induced oral conditions include altered taste, gingival hyperplasia, and infections (Table 2^4,13,14). To develop strategies to manage and prevent these AEs, pharmacists must be able to identify the offending agents.¹³

Conclusion

To maintain good oral health, referrals to a dentist when warranted and regular dental checkups are crucial. Unfortunately, many patients have barriers to dental care, and pharmacists may be the first or only contact with a health professional. Pharmacists are well positioned to help patients take care of their dental needs and promote oral health awareness.

Natalie Espeso is a PharmD candidate at the University of Connecticut School of Pharmacy in Storrs.

References

1. Oral health fast facts. CDC. Updated November 3, 2020. Accessed January 4, 2022. https://www.cdc.gov/oralhealth/fast-facts/index.html

2. Oral health conditions. CDC. Updated November 3, 2020. Accessed January 4, 2022. https://www.cdc.gov/oralhealth/conditions/index.html

3. Adult oral health. CDC. Updated December 2, 2020. Accessed January 4, 2022. https://www.cdc.gov/oralhealth/basics/adult-oral-health/index.html

4. Wick JY. Oral health in the long-term care facility. Consult Pharm. 2010;25(4):214-224. doi:10.4140/TCP.n.2010.214

5. Virdee J, Amin K. Improving oral health: preventative care messages in community pharmacy. Pharmaceutical Journal. February 5, 2020. Accessed January 7, 2022. https://pharmaceutical-journal.com/article/ld/improving-oral-health-preventative-care-messages-in-community-pharmacy

6. Mouthrinse (mouthwash). American Dental Association. Updated December 1, 2021. Accessed January 5, 2022. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/mouthrinse-mouthwash

7. Accepted products. American Dental Association. Accessed January 6, 2022. https://www.ada.org/resources/research/science-and-research-institute/ada-seal-of-acceptance/product-search

8. Toothbrushes. American Dental Association. Updated February 26, 2019. Accessed January 5, 2022. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/toothbrushes

9. Community water fluoridation. CDC. Updated April 1, 2016. Accessed January 6, 2022. https://www.cdc.gov/fluoridation/faqs/community-water-fluoridation.html

10. Fluoride: topical and systemic supplements. American Dental Association. Updated July 15, 2021. Accessed January 6, 2022. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/fluoride-topical-and-systemic-supplements

11. Pharmacy. Oral Health Foundation. Accessed January 5, 2021. https://www.dentalhealth.org/pharmacy

12. Donaldson M, Goodchild JH, Epstein JB. Sugar content, cariogenicity, and dental concerns with commonly used medications. J Am Dent Assoc. 2015;146(2):129-133. doi:10.1016/j.adaj.2014.10.009

13. Lam A. Medications and oral health. Aging Well. Accessed January 5, 2021. https://www.todaysgeriatricmedicine.com/archive/083109p22.shtml

14.ADA Division of Medications. For the dental patient. How medications can affect your oral health. J Am Dent Assoc. 2005;136(6):831. doi:10.14219/jada.archive.2005.0269

15.Higgs G. Medications and their effects on oral health. Guidelines for Nurses. June 17, 2019. AccessedJanuary 5, 2021. https://www.guidelines.co.uk/expert-articles/medications-and-their-effects-on-oral-health/455380.article