Annual Report Of The Chief Dental Officer 2012

3. Oral Health Promotion

3.1 Common Risk Factors and Oral Health Promotion

It is now widely believed that the risk factors associated with oral disease are more than lifestyle behaviours. Access to, and the use of, oral health services plays an important role in preventing oral disease, while socio-economic deprivation and environmental factors are strongly associated with ill health, including oral disease.

It has long been recognised that oral health promotion needs to be firmly integrated with general health promotion in order to maximise its effect; together, they can tackle the risk factors associated with the main chronic non-communicable diseases. A united approach simultaneously helps reduce the incidence of obesity, heart disease, stroke, diabetes, cancer and mental health, as well as oral diseases, and supports a health service that is striving to tackle ill health and reduce mixed messages from healthcare professionals for the general public (www.who.int/oral_health/strategies/cont/en/index.html).

This approach was used in Oral Health and Nutritional Guidance for Professionals (www.healthscotland.com/documents/5885.aspx), published in 2012, by NHS Health Scotland; the aim was to produce user-friendly guidance that was evidence-based, consistent and agreed by a range of healthcare professionals.

Poor oral hygiene is the main cause of periodontal (gum) disease, while the main causes of dental caries (decay) are poor oral hygiene and poor diet.

3.2 Fluoride

The benefits of fluoride can be delivered in a variety of ways. Brushing with fluoride toothpaste is considered to have been the single biggest contributor to the reduction in dental caries in children over the past 30-40 years. Well established programmes have focused on organised tooth brushing as part of the daily routine in nursery and targeted school settings and have supplemented the key message to brush twice a day at home. Other methods of delivery involve the widespread fluoride varnish programmes described in section 4.2.

3.3 Improving Diet and Reducing Sugar Intake

The frequent consumption of sugar is strongly linked to dental decay. Across Scotland, the dental team and partner agencies play an important role by offering dietary advice and encouraging healthier behaviours that help reduce the frequency and amount of consumption of sugary foods, particularly between meals.

Diets high in sugar and fat and low in fibre and essential vitamins are associated with coronary heart disease, stroke, obesity, diabetes and periodontal disease, as well as other diseases of the soft tissues of the mouth.

3.4 Reducing Smoking

The effect of tobacco use is well recognised. Tobacco contributes to periodontal disease and the rarer but potentially life-threatening oral cancer.

Reducing smoking is an established HEAT target, and members of the dental team are ideally positioned to engage with the "well" smoking population who attend dental surgeries for regular dental check-ups. The dental team are encouraged to actively help their patients and increase the number of referrals into the Stop Smoking Services.

3.5 Reducing Alcohol Consumption

Alcohol consumption increases the risk of high blood pressure, liver disease, coronary heart disease and oral cancer. Alcohol is also a major factor in many social problems, including violence and injuries to the face and mouth.

NHS Health Scotland's recently published paper Alcohol and Oral Health: Understanding risk, raising awareness and giving advice (www.healthscotland.com/documents/6124.aspx) highlights the link between alcohol consumption and oral health. It provides guidance on how to increase the dental team's confidence to raise the issue of alcohol consumption with their patients using behaviour change techniques.

The key messages to improve oral health for the population of Scotland are:

• Brush teeth with fluoride toothpaste twice a day - morning and particularly last thing at night.
• Spit out the excess toothpaste and do not rinse with water.
• Reduce sugar intake and improve diet - the frequent consumption of sugar is strongly linked to dental decay. Keep sugary food and drink to meal times.
• Visit the dental team as advised for regular check-ups.

Results from the 2011 Scottish Health Survey (www.scotland.gov.uk/Publications/2012/09/7854/15) report that almost 96% of adults with some natural teeth brushed daily with fluoride toothpaste. The use of daily mouthwash in 2009/2011 was self-reported by 45% of women and 36% of men, and twice as many women stated that they flossed daily (33% compared with 17% of men).