Oral Hygiene

• those affecting the teeth themselves and
• those affecting the oral mucosa in the areas around the mouth. 

In terms of the teeth the main issue is going to be a simple toothache, usually a continuous throbbing pain in the tooth. It can be caused by a variety of different triggers, it might just be simple sensitivity, especially made worse by hot or cold things or sweet things. It could be a dental abscess, which is an infection in the tooth, it could be a lost filling, maybe a broken tooth, a whole host of things could cause it. In contrast, a localized pain in a tooth socket a couple of days after having an extraction, could be a sign of a dried socket. Signs would include it being very tender, signs of a broken down blood clot include dry or even fresh blood around the area, no signs of healing or very poor healing and there may even be some bone showing through. 

• So as well as the teeth themselves, the supporting structures of the teeth, i.e. the gum, can be infected by a whole variety of things as well. There are two main ones, firstly, gingivitis which is more commonly known as gum disease. It is caused by plaque in between the teeth and the gums which causes inflammation of the gums and bleeding especially during or after brushing the teeth. The other main disease affecting the gums is always the next stage of gingivitis called periodontitis.
• Gingivitis affects the gums mainly, whereas periodontitis spreads further and affects the bone surrounding the tooth. So signs would be bleeding of the gums but also recession of the gums, causing more of the tooth to be seen because the gums are dying off and as well the tooth becomes more mobile, it might become looser in the socket and may fall out if the problem is left go long enough. Gingivitis is reversible with fairly simple treatment but periodontitis isn’t and it’s really all about damage control with periodontitis and trying to reduce how much gum or even how many teeth are lost. So it’s important to get treated before it gets to that stage.
• Gingival overgrowth is an unwanted side effect of some drugs, especially phenytoin which is used for epilepsy, cyclosporine, calcium channel blockers especially nifedipine which is often used for angina. It’s basically swelling and inflammation of the gums not too unlike what’s seen in gingivitis. 

Moving away from the teeth and the gums and onto the mucosa and the areas around the mouth, herpetic infections are quite common so infections caused by the herpes virus. There are two main types: 

The first: is seen in children and it’s just a primary acute infection often confused with teething. So the child may be unwell, very irritable, the gums are going to be fiery red, very tender, that’s why it’s often confused with teething. There may be vesicles around the mouth, similar to cold sores or they may burst to leave an ulcerated area around the mouth.

The second: then is an extension of the first one, so if a child gets a herpetic infection, it generally hangs around in the body and can flare up from time to time throughout their lives as teenagers or adults and it flares up as a cold sore basically. So cold sores appear as vesicles just on the surface of the lips and they usually burst after a couple of days leaving a raw area, then crusts over. This happens over a period of 7-10 days from when they first appear to when they finally disappear. So the two main herpetic infections you can get in the oral mucosa are the primary acute one in childhood, which then hangs around and flares up throughout the patient’s life as cold sores which is the second herpetic infection.

• Dry mouth is another common problem, again often due to drugs like some anti-histamines, drugs used for Parkinson’s disease and some antidepressants. A patient with a dry mouth, is far more prone to infections, even cavities and bad breath as well, the medical term for which is halitosis. Ulcers are obviously a very common problem and is often recurrent. It usually occurs as small cracks around the mouth, can easily become infected and usually appear with a yellow flap of skin covering them. 
• Finally then, thrush is a pretty common complaint of the mouth especially in young babies but can occur in adults as well. It usually involves soreness of the mucosa and the tongue or the areas around the mouth would be covered in a white plaque. If you scrape away this white plaque it leaves a very raw bloody area underneath, it’s very common in babies and young children, but also often seen in adults taking antibiotics or taking steroid inhalers.

Oral and dental treatments

• So in terms of treating problems in the mouth, if a patient has lost a filling which is causing a tooth ache, there are temporary fillings available where the patient basically just mixes the the ingredients together and forms a thick paste. Then the patient pops it into the cavity, it is important though to emphasise that this is temporary until they can get to a dentist in order to get the filling replaced. For sensitive teeth there are sensitive toothpastes available, sensodyne being the most well known one, if there is excessive sensitivity and it’s really bothering the patient, they probably have a cavity, so refer to the dentist for a filling most likely. For just a general toothache with no clear cause there’s not a whole lot you can do besides refer. Painkillers tend not to provide the amount of pain relief that a patient would like but if they are going to try it, which they probably will, it’s best to try a non-steroidal anti-inflammatory drug for example ibuprofen which is nurofen these tend to be good for any sort of bone pain like dental pain.
• The usual rules apply for this class of drug, so not to be taken if the patient is pregnant, if they have a history of stomach ulcers or if they’re asthmatic. Some people say that holding a dissolvable aspirin tablet just to the side of the gum that’s causing bother helps but it doesn’t and the patient could end up getting an aspirin burn on their gum so this doesn’t work. If they want pain relief take the tablets but holding aspirin to the gum doesn’t work. If there is a lot of bleeding after an extraction it can often be treated just by using pressure, so biting down on a padded gauze can help. However, if it just won’t stop bleeding they might need referral as they may need packing or stitches.
• In mild cases of gum disease, corsodyl mouth wash or oraldene is another one, are often enough to treat it. So for gum disease a month’s regime of using it twice a day, so morning and evening, is generally recommended. Usually for the corsodyl, if you use it beyond a week there’s a chance that it could stain your teeth, but the dentist can just remove this very quickly with a simple cleaning.
• For dry mouth, there are salivary substitute preparations, Biotene do a range of products that tend to work pretty well for people. Basically they just replace the saliva in the mouth and by treating dry mouth you’re reducing the chance of cavities, infections and often solves bad breath as well.
• In terms of ulcers, if the patient has a long history of them or if they’re recurrent and they haven’t been checked out before they should see their Doctor. It could be a sign of a deficiency like vitamin B12, iron or folate, some sort of deficiency or indeed indicate something more serious going on in the stomach. If they have been checked out before or if it’s just a once off, you can get symptomatic relief from preparations like Anbesol or bonjella which basically coats the ulcers, the bonjella has a pain killer in it similar to aspirin. Corsodyl can offer a lot of relief from ulcers.
• For coldsores, zovirax is the main one, there is a generic of it now which is the same only cheaper. The important thing about zovirax is that you start using it as soon as you feel a tingling on the lips, before any vesicles appear. Use it 4-5 times a day and starting as early as possible because it’s far more effective getting it before it appears.
• In terms of thrush, it is a candidal fungal infection which can be treated using daktarin gel. It is the best over the counter product you can get. It’s important to keep using it a couple of days after symptoms have disappeared just to make sure the infection is well and truly gone.
• So obviously the best treatment for anything is prevention, so the improtance of good oral hygiene can not be over stated. Brushing and flossing are still the best way to prevent any problems we’ve discussed above. And as well paying attention to your diet, so trying to avoid or reduce the amount of fizzy drinks or any foods with a high sugar content. Paying a little bit of attention to these goes a long way to preventing any of these oral or dental problems.

Garvan J. Lynch M.B.A. (Public Health) D.I.C.