Oral health: What your mouth is really telling you

Why oral health matters

The good news is that as a country, our oral health is improving. Between 1998 and 2009 the prevalence of tooth decay in England fell dramatically from 54% to 31% overall. And, looking after our oral health is linked to better health overall.

But there’s still work to be done. Studies show those on lower incomes are more likely to experience problems with their teeth and gums. Poor oral health is also linked to other diseases.

For example:

  • People with gum disease are more likely to have Alzheimer’s disease,  diabetes, cardiovascular disease, metabolic syndrome and a range of other illnesses.
  • Nearly half of people with mental health problems, trauma and housing instability report poor or fair oral health. 
  • Gum disease is the most common inflammatory condition, affecting nearly half of adults in the UK and 60% of those over 65.  

It’s not clear whether dental infection has a part to play causing these conditions. They are linked but that does not mean that one causes the other. It may be that the association is through some other factor such as smoking, poor diet and stress; things that affect the poor and disadvantaged disproportionately.

How to recognise gum disease

Periodontal disease or gum disease is caused by a bacterium Porphyromonas gingivalis. It affects the gums and bones supporting the teeth (periodontal tissue) which become red, swollen and bleed. In the early stages, the disease is called gingivitis and it can often go unnoticed as infection below the gums is protected by plaque, where it can sit shielded and slowly and silently cause damage over years. As it progresses, chronic inflammation causes the gums to pull away from the teeth, leading to loosening, loss of bone and teeth. Often, it’s accompanied by bad breath, also known as halitosis.

Contributing factors to poor oral health

Factors that influence poor oral health include chronic stress, poor diet including lack of nutrients, smoking, other environmental agents and poor dental hygiene. It links to non-oral diseases only in certain conditions and genetic susceptibility and lifestyle factors play an important part.    

For most people, good dental health can be maintained and gum disease can be prevented with good oral hygiene and simple lifestyle changes that focus on eliminating the contributing factors. Starting a good dental routine from an early age can pay dividends later.  

Here are a few things to consider.

Simple ways to brush up on your dental health

1‍. Good dental hygiene

Following a rigid dental hygiene routine is key to preventing and removing build-up of plaque. Brush twice or more daily for two minutes with a fluoride toothpaste. Fluoride is a mineral that is sometimes added to our water supply as it can help prevent tooth decay. It’s also present in varying amounts in toothpaste where it’s measured in parts per million (ppm). Look for toothpastes containing 1,350 to 1,500ppm fluoride.

Fluoride mouthwashes can also help prevent tooth decay and are sometimes prescribed by dentists. But you should use mouthwash at different times to brushing, to avoid washing off the toothpaste and fluoride it contains. Avoid mouthwashes that contain alcohol, particularly for children. Flossing or using interdental brushes may also help. There’s more information on this below.

Following a rigid dental hygiene routine is key to preventing and removing build-up of plaque. Brush twice or more daily for two minutes with a fluoride toothpaste. Fluoride is a mineral that is sometimes added to our water supply as it can help prevent tooth decay.  It’s also present in varying amounts in toothpaste where it’s measured in parts per million (ppm). Look for toothpastes containing 1,350 to 1,500ppm fluoride. Fluoride mouthwashes can also help prevent tooth decay and are sometimes prescribed by dentists. But you should use mouthwash at different times to brushing, to avoid washing off the toothpaste and fluoride it contains. Flossing or using interdental brushes may also help. There’s more information on this below.

2. Visit the dentist for regular for check-ups  

Going to your dentist or oral health professional once or twice per year for regular check-ups is a vital part of keeping your teeth and gums in good health and to notice and deal with problems early. It’s particularly important to take children to regular checks as soon as the first tooth erupts to promote good dental health for life. Everyone is entitled to dental care on the NHS, but it is one of the few  services where you have to pay a contribution towards the cost of your care. However treatment is subsidised by the state so it’s cheaper than going private and it is free for certain people: for example under 18’s, pregnant women and those on income support and other benefits. There’s a full list in the references section below and information on how to find an NHS dentist near you. Dental surgeries will not always have the capacity to take on new NHS patients: you may have to join a waiting list or look for a different dentist further away. You can also pay for treatment privately.

3. Avoid sugar in food and drinks

When we eat sugar, bacteria in our mouths breaks it down and produces an acid which in turn can dissolve the tooth surface. Try to avoid food that contain free sugars: that’s sugar that’s been added to foods and drinks to sweeten them. You can find out if sugar has been added by reading the label. Free sugars are also found naturally in honey, unsweetened fruit juice, vegetable juices and smoothies. Fizzy drinks, even the no-sugar kind, also contain acids that can erode the outer surface of the tooth.

4. Eat a nutrient rich diet

A Japanese trial concluded that tooth loss was linked to poorer nutrition. Intake of key nutrients like vitamins A, C, dairy products and green-yellow vegetables was lower among those with fewer teeth. They were also found to consume more confectionary products.  Our article, What’s in a Healthy Diet might help you check you’re eating the right foods.

5. Reduce alcohol intake

Alcohol, especially mixed with fizzy drinks, can lead to increased levels of acid in the mouth, which may cause tooth erosion.

6. If you smoke – quit

Clinical studies tend to suggest that smokers have a higher risk of periodontal disease than non-smokers. A 2007 study found that edentulism, or tooth loss, was 8% higher among smokers than those who’d never smoked.

7. Try to de-stress

In a 2010 study into how exam stress affects oral health, students had higher rates of plaque and gingivitis when compared with controls. It’s not always easy to reduce stress levels but there are things you could try, like talking to someone, doing mindfulness exercises and using relaxation techniques like breathing and yoga. You might find it useful to read our article on 7 ways to feel happier, linked in the references section.

To floss or not to floss?

Most dentists recommend we should use floss to clean in between our teeth. A recent study showed that using devices like floss and interdental brushes in addition to toothbrushing, may reduce gingivitis in the short and medium term. It’s unclear if it reduces plaque.

However, some argue that overly rigorous cleaning techniques can cause damage and provide a route for infection to enter into the blood stream. A sensible approach might be to avoid overly rigorous brushing and flossing and if you notice persistent bleeding, get some expert help from your dentist.

Keep smiling: take control of your oral health

There are compelling reasons to pay attention to dental hygiene, not only to enjoy better oral health but to reduce the many risks associated with gum disease and dental infection.  Being more aware of the risks means that you’re better placed to take action.

If you decide to make a change you can retake the Oral Health Check in your Evergreen Life app in 3 months to monitor your progress.

📲 Not got the app yet? Download the app here and take your available questionnaires including the Dental Health Check to better understand your health and wellbeing.
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References