Australian Dental Perspectives

Oral diseases are among the most common health problems experienced by Australians, with dental caries, edentulism and periodontal disease included in a list of the top five most prevalent health conditions in the nation.1 Almost $4 billion was spent on dental services in the year 2001-2002, accounting for 5.5 percent of total health expenditure.1

With this in mind, members were asked at the last meeting of the PDF to go "back to basics" and identify the factors critical to good oral health. Using these factors as a foundation, the members developed a model of the ideal daily home oral care routine. The workshop ended with a discussion of how the messages about preventive oral health should be delivered to consumers in an effort to reduce the rate of oral disease within the community. Below is a recap of this thought-provoking session.

Seven Factors to Good Oral Health

After much discussion and debate, the members of the PDF identified seven factors critical to good oral health:

• Good oral hygiene
• A healthy and nutritious diet
• Good systemic health
• Regular check-ups with a dental practitioner
• Competent, qualified and experienced dental practitioners
• Employment – people who are working and receive a regular income are more likely to maintain good oral health habits
• Education – people need to be informed about the importance of good oral health and what they need to do to achieve it.

The Ideal Daily Oral Care Routine

With good oral hygiene nominated as an essential element in achieving oral health, the group then developed a model of the ideal daily oral health care routine for Australians. The routine included the following components:

1. Floss/interproximal cleaning - for where brushing does not reach
2. Brush/tongue cleaning - for removing plaque
3. Rinse with an antiseptic mouthwash - for 'killing' remaining bacteria
4. Chew gum after meals - for buffering, pH level and saliva.

When deciding on the ideal model, the group made reference to a study recently published in the Journal of Dental Research which shows the addition of an essential oil-containing antimicrobial mouthrinse (Cool Mint Listerine® Antiseptic), to a daily dental routine of brushing and flossing, provides a clinically significant benefit in helping to reduce gingivitis and plaque build up.²

Conducted over six months, the randomised, observer-blind, controlled study was undertaken to help understand the incremental benefit of adding an antiseptic mouthwash to a regime of brushing and flossing. The study then examined the results of the new regimen versus brush/floss and brushing alone.

After six months, the subjects using the antimicrobial mouthrinse on top of their normal brushing and flossing regimen exhibited significantly lower mean plaque and gingivitis scores than those using the control rinse. Amongst subjects using Listerine, whole mouth plaque was 51.9 per cent lower, with whole mouth gingivitis 21 per cent lower. Overall, the addition of Listerine resulted in significantly greater reductions in interproximal plaque and gingivitis versus brushing and flossing alone. As such, this study provides strong support for the PDF's recommendation to patients of a three-step daily oral health routine of brushing, flossing and rinsing.

Communicating the Importance of Good Oral Health

The PDF also discussed the best way to share the oral health care model with patients and communicate the importance of preventive oral health.

The members agreed the dentist needs to work in partnership with their patient, with one-on-one contact between patients and oral health professionals identified as essential.

In terms of overcoming pre-conceived ideas and bad behaviours, the group identified that it was important to promote the good behaviours rather than focusing on the bad. Therefore, during consultations, oral health professionals should discuss the value of good oral health and preventive dentistry, and offer encouragement and ongoing positive reinforcement, rather than chastise patients for poor habits.

The oral health message should also be tailored to suit the patient. The oral health professional should consider the age, sex, general health and economic status of the patient and provide guidelines that are suitable and achievable for the patient.

It is also beneficial to have leaflets and brochures on oral health available in the dental surgery for the patient to take home with them, so the oral health message continues to be received after they leave the dental setting.

In conclusion, the PDF agreed patients need to have a greater understanding of the importance of good oral health. Oral health professionals can help them achieve this by following some simple guidelines on the best way to communicate and recommending a three-step daily oral health care routine.

References

1. Healthy Mouths, Healthy Lives: Australia's National Oral Health Plan 2004-2013. Prepared by the National Advisory Committee on Oral Health (a committee established by the Australian Health Ministers' Conference). July 2004.
2. Charles C, Sharma N, Qaqish J et al: Efficacy of a Brush, Floss, Rinse Regimen Compared to Brushing and Flossing Alone: A Six Month Study. JADA, April 2004.