Blogs and news
We will be updating this page with blogs to provide you with different perspectives from our GUIDE oral health community and regular news updates on how we are progressing.
Oral health is crucial to overall wellness. Brushing your teeth removes plaque and bacteria that build on the teeth and around the gums. Plaque can cause cavities, tooth decay, and even periodontal disease if it isn't eliminated daily. Brushing your teeth regularly helps preserve your teeth from decay and infection.
Brushing your teeth, gums, and tongue properly is essential. The advice from NHS (1) is to brush your teeth twice a day (before bed and at least once more during the day) for two minutes with a soft-bristled toothbrush using fluoride toothpaste. During your two-minute brushing session, make sure you brush the front, back, and chewing surfaces of your teeth. Brush your tongue after brushing your teeth to remove bacteria.
Brushing your teeth before breakfast is the best time to do so, or wait 30 minutes to an hour after breakfast to avoid damaging the outer layer of your teeth (also known as tooth enamel). Brushing teeth as soon as you wake up helps to remove bacteria while also providing a protective layer on teeth, against acids in food. Drinking water or chewing sugar-free gum after eating and before brushing your teeth helps to reduce the bacteria in the mouth.(2) Your brush should be the right size and shape for your mouth, allowing you to comfortably reach all areas.
Brushing your teeth with hard bristles causes gum inflammation (for example, bleeding gums) (3). Brush your teeth in a back-and-forth motion as little as possible. A circle is the most effective design to use since it moves particles both horizontally and vertically between the teeth. Brush your teeth gently in slow circular motions to remove dental plaque from all surfaces. Maintaining a 45-degree angle between your toothbrush and your teeth is the best position for removing bacteria, plaque, and residual food from your mouth. Bacteria can hide on the inside of back molars, so pay extra care there. Brushing your teeth in a single direction might harm your gums and enamel. Brush softly and lightly to avoid irritating your gums.
Reference:
1. How to keep your teeth clean [Internet]. nhs.uk. 2018. Available from: https://www.nhs.uk/live-well/healthy-body/how-to-keep-your-teeth-clean/
2. Richards D. Sugar free gum and streptococcus mutans levels - National Elf Service [Internet]. National Elf Service. 2021. Available from: https://www.nationalelfservice.net/dentistry/oral-health-other-health-conditions/sugar-free-gum-streptococcus-mutans-levels/
3. Donovan J. 8 Mistakes We Make Brushing Our Teeth [Internet]. WebMD. 2016. Available from: https://www.webmd.com/oral-health/features/brushing-teeth-mistakes
According to the Centers for Disease Control (CDC), these are the top measures adults can take to maintain good oral health. Were you aware of all of these measures? Which ones do you do already? Which measures would you add?
- Drink fluoridated water and brush with fluoride toothpaste.
- Practice good oral hygiene.
- Brush teeth thoroughly twice a day and floss daily between the teeth to remove dental plaque.
- Visit your dentist at least once a year, even if you have no natural teeth or have dentures.
- Do not use any tobacco products.
- If you smoke, quit.
- Limit alcoholic drinks.
- If you have diabetes, work to maintain control of the disease. This will decrease risk for other complications, including gum disease. Treating gum disease may help lower your blood sugar level.
- If your medication causes dry mouth, ask your doctor for a different medication that may not cause this condition. If dry mouth cannot be avoided, drink plenty of water, chew sugarless gum, and avoid tobacco products and alcohol.
- See your doctor or a dentist if you have sudden changes in taste and smell.
- When acting as a caregiver, help older individuals brush and floss their teeth if they are not able to perform these activities independently.
This information is taken from the CDC website.
This post is adapted from a post originally available in the Evidently Cochrane website
Scale and polishes and education are used as the main strategies to prevent gum disease in the National Health Service (NHS). However, there was no strong evidence to support they work before the IQuaD study was done. This blog post focuses on describing the largest trial investigating the effect of scale and polish and/or education in preventing bleeding gums. IQuaD was conducted by our team that hosts the GUIDE oral and dental health platform.
The IQuaD Trial: investigating scale and polish
IQuaD – Improving the Quality of Dentistry - was a ground-breaking trial: it was testing whether 6-monthly scale and polish improved gums’ health compared with yearly scale and polish or none over three years on regular attenders to the dentist with healthy gums. To my surprise as a dental patient, this was the largest trial ever to test this question. Even though this was such an engrained health behaviour in the UK and worldwide, there was actually no evidence behind the idea that a scale and polish every six months helps keep your gums healthy.
How do we measure gum health?
We collected data on bleeding on probing, calculus (tartar) and pocket depth as indicators of your gums’ health. Initially I was surprised about this. I thought bleeding gums were just a result of brushing teeth too hard. I did not realise they were indicative of gum inflammation and could lead to more serious disease and even tooth loss. This is the thing about gum disease: it is silent and it can secretly deteriorate until it is found. IQuaD also tested whether personalised oral hygiene advice improved gums’ health or patients’ self-confidence in their ability to brush or floss compared with routine advice (both given by the dentist or hygienist).
No evidence of a difference in bleeding gums
The results are now out and so is the Cochrane Review (a review including all the best evidence available related to the effectiveness of scale and polish) that includes them. To summarise IQuaD: there is no evidence of a difference in bleeding between 6-monthly, 12-monthly or no scale and polish over three years in healthy adults that attend NHS dentists in the UK. The differences found were very small and we were confident they excluded the possibility of a clinically meaningful difference between the groups. The same was observed for personalised versus routine advice in bleeding and self-confidence on the ability to brush and floss. The Cochrane Review supports these findings.
We prepared an infographic (below) to disseminate the results to trial participants and dentists with the support from the public and patient’s involvement group at the Health Services Research Unit. The group’s main concern when introducing these results to the public was clear: scale and polish might not improve your gum health, but we should make it clear that patients still need to go back and get check-ups done. Should we?
A more complicated story?
We were not just interested in the clinical effectiveness of scale and polish; we also looked at how much people valued the treatment and why. We conducted a survey asking people’s preferences and willingness to pay for different dental packages. The work, led by Dr Dwayne Boyers, is described here. A brief summary is: the general population value scale and polish and personalised education. Responders to the survey showed a willingness to pay more per year to have their teeth look and feel very clean (compared with look and feel very unclean) than their willingness to pay to never have bleeding gums (compared with having bleeding gums very often). This shows the general population attaches a greater value to shifts in their aesthetic outcomes compared to changes in bleeding gums.
The results can lead to a more complicated story. If people feel better after having a scale and polish and it contributes to their confidence and their appearance, should we be including it as part of the NHS even though it does not improve gum health?
If you would like to discuss these results, please head to our challenges and select the one the you think is the most appropriate to share your ideas and thoughts.
Bottom line
Unfortunately, many treatments provided in primary care dentistry have been based in anecdotes and weak evidence. With IQuaD and Cochrane Reviews on topics such as scale and polish and dental check-ups, we hope to change that and contribute to an evidence-base practice of dentistry. We need good quality evidence to support the treatment we get in our dental practices and how the NHS funds are spent. More research is needed on how to prevent gum disease: even though its cornerstones (scale and polish and oral hygiene advice) have been questioned, there is still a lot to be done. Different types of education or targeting specific groups could lead to different conclusions. This is why your help, as part of the GUIDE oral and dental health community, is so important!
Funding note
IQuaD was funded by the NIHR Health Technology Assessment (HTA) programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Hello and welcome to the GUIDE platform!
We are a group of researchers, dentists, guideline developers and patients aiming to improve oral health and dental services to ensure patients and members of the public receive the best possible treatment. However, we need your help to achieve this. We would like to hear your ideas, experiences and thoughts on how together we can improve oral health and dental services.
To find out more about the project, you can go here.
For now, I will tell you a bit more about citizen science, what is it in this context and what we aim to achieve. Other blogs will focus on participatory research and patient and public involvement, oral health and dental services and ideas generated by the platform users.
Citizen science
Citizen science includes a range of different types of projects where citizens (members of the public) can be active in one or more stages of the research project and help generate new knowledge or understanding. Ultimately, it aims to open up science and research, making it a more democratic and participatory process. This can lead to mutual learning, between citizens and scientists, quicker and more sustainable changes. Traditionally, it has been applied to environmental sciences, but it has slowly been adopted by other science fields, including health.
The European Citizen Science Association defines 10 principles that should be incorporated when planning a citizen science project [1]. They include the fact that citizen science should benefit both citizens and scientists from taking part. Citizen science project data should be publicly available and citizen scientists should receive feedback from their projects. Citizen scientists are acknowledged in all outputs, including scientific publications and presentations.
Citizen science in healthcare
Citizen science in healthcare is a relatively new concept, but it has been successfully implemented in the past. Examples include a platform for citizen scientist with psoriasis to learn more about their health, share data and ask their own research questions [2]. Another way to bring citizen science into healthcare improvement is to invite members of the public to generate ideas on how to make services better.
Idea generation
Idea generation involves collecting ideas from a group of people in to solve specific problems or generate innovation. Idea generation and management can be carried out on a large scale engaging with thousands or tens of thousands of participants [3].
Traditionally, generating ideas for new research projects and to improve healthcare has been done by “experts” but members of the public or patients have been often excluded from this process. Citizen science and online platforms bring the opportunity of making this process more democratic and transparent. People attending health services will have their own unique experiences to share that can help generate solutions and innovation and improve experiences.
Organisations like Starbucks and Dell, as well as the NHS [4,5,6] have used these platforms to help make decisions, develop new and innovative products, and improve existing products.
How do we take the ideas forward?
Different projects have implemented ideas in different ways. In the GUIDE platform, we will select the most feasible and popular ideas to take forward. We will invite citizens to stay involved in the improvement and refinement of these ideas and in developing research projects that can help evaluate them in the real world.
References
1 - European Citizen Science Association: https://ecsa.citizen-science.net/. As of 16 Sept 2021, link to the 10 principles here: https://osf.io/xpr2n/wiki/home/
2 - Sanchez et al. 2018. Building a Citizen Pscientist: Advancing Patient-Centered Psoriasis Research by Empowering Patients as Contributors and Analysts. Dermatol Ther. As of 16 Sept 2021, available here: https://pubmed.ncbi.nlm.nih.gov/29876724/
3 - THIS Institute. 2018. "Citizen science: generating ideas and exploring consensus." Report available here: https://www.thisinstitute.cam.ac.uk/research-articles/citizen-science-generating-ideas-exploring-consensus/
4 - Hossain et al. 2017. ‘How Do Digital Platforms for Ideas, Technologies, and Knowledge Transfer Act as Enablers for Digital Transformation?’ Rochester, NY: Social Science Research Network. As of 16 Sept 2021, available here: https://papers.ssrn.com/abstract=3045012
5 - Benbya et al. 2017. ‘Harnessing Employee Innovation in Idea Management Platforms: Lessons from Allianz UK.’ Rochester, NY: Social Science Research Network. As of 16 Sept 2021, available here: https://papers.ssrn.com/abstract=3041319
6 - Saldivar et al. Idea Management Communities in the Wild. As of 16 Sept 2021, available here: http://www.carlosrodriguez.info/papers/Idea-Management-Communities__CTS2016.pdf