Helping your patients prevent oral disease

07 January 2023

Kimberly Lloyd Reese discusses the importance of creating a great routine.

Kimberly Lloyd-Rees discusses the importance of creating a great routine.

Plaque control is crucial for keeping the mouth healthy and preventing diseases such as caries and periodontitis from developing. Creating good oral hygiene routines at a young age will help patients understand the role they play in preventing diseases as they grow. Oral health in general is improving in England, but caries remains the most common oral disease in children and young people. For example, in 2019, just under a quarter of five year-olds had tooth decay, and in 2020 11 per cent of three year-olds had visible tooth decay. This is troubling as caries, as well as gingivitis and periodontitis, are largely preventable with good oral hygiene, so it is vital to promote its importance to patients of all ages and parents in practice to encourage good habits at home.

The root cause

Bacterial plaque is the root cause of gingivitis, periodontitis, and caries. This relationship between dental plaque and oral diseases is well established. However, pre-existing medical conditions may also influence patients’ susceptibility to oral diseases. A recent study found that, “recipients of a bone marrow transplant were predisposed to more severe arthritis if their donor has inflammatory gum disease.” This was shown to be true in reverse as well, with researchers suggesting that patients who already have conditions like arthritis are more at risk for developing gingivitis and periodontitis. This may be because Porphyromonas gingivalis, the pathogen which causes periodontitis, influences the citrullination process, which in turn leads to rheumatoid arthritis.

A recent study also suggests a link between both type 1 and type 2 diabetes and caries. Suggesting that diabetes causes the enamel to become significantly softer after just 12 weeks, and dentine to become weaker after 28 weeks. Therefore, to minimise the impact, diabetic patients should maintain excellent oral hygiene, undergo restoration procedures when needed, and follow any recommendations for a non-cariogenic diet.

Oral hygiene for prevention

Periodontitis affects around half of the population and causes bleeding and tooth loss, but, like caries, it is usually preventable with good plaque control. As such, plaque must be actively removed on a regular basis, hence brushing is recommended twice daily, and interdental cleaning once per day.

Those with pre-existing conditions should be advised to take particular care when undergoing their daily oral hygiene routine. However, this may be difficult for patients with arthritis, particularly if it affects their hand and jaw joints. Even when patients brush with relatively good frequency, if their technique isn’t adequate, this could still lead to periodontitis and tooth loss. It may be appropriate in these cases for patients to use more specialist cleaning tools – including electric toothbrushes for improved technique – and attend more regular dental hygiene appointments to ensure effective and regular plaque removal. This will help to prevent the build-up of bacterial plaque and therefore the development of oral diseases.

The benefits of interdental cleaning

Even though toothbrushing is essential, many only brush the occlusal and buccal surfaces. Many patients, unless they’ve received specific instructions to do so, don’t clean interdentally. Its vital that patients are reminded of the importance of interdental cleaning daily, as these are areas in which caries commonly develop and gingival and periodontal lesions are often found.

There are a number of options for interdental cleaning which may be suitable for your patients including dental floss, interdental brushes, and single tufted brushes. Larger interdental brushes may be required for some patients. The brush should fit snugly, without the wire rubbing against the tooth, so a patient may need various sizes to ensure a good fit for different mesiodistal spaces. If the smallest size (4 mm) is too big, the patient should not force it, but instead use dental floss if they are able to. It’s important that plaque removal is still achieved in all spaces, and this is most effectively achieved with the appropriately sized tools. Interdental brushes are also easy to use for many patients which may make it a more appropriate choice for patients with limited dexterity.

For your patients looking to improve their interdental cleaning, recommend the range of interdental brushes from Tandex. They offer tools of varying sizes to accommodate the needs of your patients, including the Woodi which is made using sustainably-sourced FSC-approved birchwood handles that can be snapped off and recycled. The brushes come in six sizes, are comfortable and easy to use, and will allow your patients to enhance their oral hygiene routines.

Ensure your patients of all ages continue to attend regular dental hygiene appointments in order to monitor for signs of gingivitis, periodontitis, and caries. Preventing diseases by maintaining oral hygiene is important for your patients’ long-term health. Continue to recommend effective brushing and interdental cleaning for at home cleaning routines – as this is the first line of defence against oral disease.

References available on request.

For more information visit