Brush all you like

… but if our diet is bad and you graze, you’ll have problems; that’s the message we need to get across

07 October, 2024 / insider
Arthur Dent

Peter Mossey’s article in the last edition of Scottish Dental was interesting. Oral health, inflammatory disease, the Scottish Government’s new Determination 1 and the skills mix and its opportunities in dentistry; heady stuff. All the things that prompt a grumpy old dentist like me to get on my high horse about and ride off into the distance. So here goes and yee-ha!

Throughout my professional career, prevention, prevention, prevention has been the mantra. Meanwhile, as I wade in the trenches of Scottish decay, I wonder where has my life gone wrong? Daily, I bleat about brushing and diet. As Professor Mossey indicated, the changes to recall times save my patients (to an extent) from those dental ramblings and despite our inevitable bonhomie, the message is delivered with equal measures of mirth and reverence like a smiley, evangelist trying to swell the numbers of parishioners and keep all on the straight and narrow path.

Seriously, the change in recall times does, in my view, fail to recognise the intangible value of regular intervention and repeated reinforcement. Dentistry is the only branch of healthcare which allows for a universally regular intervention at a frequency that matters. Two years between eye examinations is good for most, statistically, but there doesn’t seem to be a parallel negativity between using your eyes on a daily basis and what we shovel into our mouths.

I suspect if seeing, smelling or touching was quite as dangerous to our faculties and the mechanisms of sensation as eating and drinking, we wouldn’t be doing half as much of it. Hearing seems to be the other sense that can be badly affected by consumption without care.

The concept of oral health affecting our bodies and, in particular, constant inflammation and its negative effects interests me. There seems to be more and more evidence relating gum disease to cardiovascular disorders. I regularly mention the way the modern diet of grazing, high sugar content and availability is as bad for the mouth as it is for the pancreas and is reflected in society through increased appetites, obesity and diabetes. As my patient list matures both in general age and a migration from me by those who don’t like my message or its delivery, type II diabetes, high blood pressure and all that goes with ageing, rears its ugly head. My message shifts to incorporate the effects of drying mouths, reduced exercise, changing diet in retired individuals and the increase in disposable income as the patients mature.

What I do believe is, the link between oral health and other health concerns is more about circumstance than direct link. By that I mean, in my experience, the type of patients with poorer oral health are those less well educated, less likely or able to care for themselves, with poorer diets, smokers, addicts, chaotic lifestyles and generally less concern for how their day-to-day habits affect life outcomes. This correlates with those in lower socio-economic groups with poorer general health earlier in life and less money or education to help them cope or alter their behaviour. My belief is that these circumstances lead to the poorer health outcomes rather than simply a lack of brushing or bad diet. It’s a chicken and egg argument which I doubt if research can sort out. Either way, I think the point stands: prevention is better than cure.

This leads me on to the skills mix and how we prevent oral disease. I believe, a quarter century on from my wide-eyed start, almost everyone knows they have to brush their teeth twice a day for a couple of minutes. That message is getting through and, I believe, is one of the biggest benefits of Childsmile. I think the importance of diet is less well understood. Lots of my patients believe if they brush twice a day, they will be immune to dental problems. We all know it’s not that simple. We have all seen patients with really good oral health and caries. I’d venture, if we had a really good diet with no processed food or unnatural sugars, we could get away without brushing twice, perhaps not brushing at all. It doesn’t work the other way; you can brush all day long but if your diet is bad and you graze, you’ll have problems.

Fundamentally, this is the message we need to get across. And, if you believe the research about direct links to oral health, inflammation and caries, then we can truly make a difference to general health. Dentists and DCPs have a huge part to play in that. However, I believe that message has to be more general. Give our public some more credit for their understanding about their lives. Start really early and accept that older people are beyond saving (orally). Educate about diet, exercise, health effects, how hospital care and routine medication costs society billions of pounds in lost worktime, inability to work, pharmaceuticals and medical treatment. If we could make our population healthier (in particular, a country with as poor general and oral healthas Scotland) then we could become a much more equal and better society.

This is not just a job for dentistry. I don’t even believe it’s really a job for healthcare practitioners. I think it’s a job for public health educators. Informing people, intervening with their habits and creating really good ones, helping those in greatest need to eat better, exercise better and reduce the burden on their bodies, their families and society at large is not the job of a dentist. Especially when we still have so much disease to treat. We can’t forget there’s a job to do looking after the people that are here and need our help.