Tackling oral care

Toothache is one of the most common reasons customers will come into the pharmacy for help with their oral care. Defined as a pain in or around the teeth, toothache can be caused by: 

• Tooth decay
• Dental abscess
• Cracked/damaged teeth
• Loose/broken filling
• Infection
• Problems with braces.

Customers may come into the pharmacy experiencing symptoms, such as:

• A sharp, throbbing or constant pain in the teeth – for some people this will only be applicable when pressure is applied to the tooth
• Swelling around the tooth
• Fever or headache
• Foul-tasting drainage from the infected tooth. 

Treatment for toothache varies depending on the severity but usually pharmacy teams can recommend painkillers such as ibuprofen, paracetamol or a pain-relieving gel. Eating soft foods such as yoghurt or scrambled eggs to avoid chewing with sore teeth or rinsing your mouth with salt water (should not be suggested for children) can also be recommended.  

Make sure to refer a customer to the dentist, not the GP as they are unable to provide dental treatment if the toothache: 

• Lasts more than two days
• Does not go away with painkillers
• Comes alongside a high temperature
• Causes pain when biting, red gums or a bad taste in the mouth
• Causes the cheek or jaw to swell. 

Refer a patient directly to A&E if the area around the eyes or neck is swollen or if swelling in the mouth or neck is making it difficult for a customer to breathe, swallow or speak.  

Gum disease is caused by a build-up of plaque on the teeth. If you do not remove plaque from teeth by brushing and cleaning in between them regularly, it can build up and irritate the gums. Symptoms of gum disease include:

• Gums bleeding when you brush your teeth, floss or eat hard foods such as apples
• Gums becoming swollen, red and sore.

If left untreated, gum disease can lead to oral conditions such as bad breath or a bad taste in the mouth, gums shrinking or teeth becoming loose and falling out. Additionally, gum disease can be associated with wider health conditions. 

"Gum disease is one of the main causes of tooth loss in adults," says Dr Nigel Carter, chief executive of the OHF. "It is also increasingly being link to other general health conditions like heart disease, diabetes and some forms of dementia."

To avoid developing gum disease or if a customer is in the early stages, pharmacy teams can offer the following advice to their customers: 

• Brush the teeth with fluoride toothpaste at least twice a day – spit after brushing, do not rinse
• Clean in between the teeth every day using floss or interdental brushes
• Replace toothbrushes every one to three months
• See a dentist and dental hygienist for regular check-ups, especially if pregnant or have type 2 diabetes
• Do not use mouthwash straight after brushing the teeth
• Avoid smoking. 

If the gum disease has progressed and is more serious, for example a customer’s teeth are loose or they have red patches in their mouth, staff should refer them urgently to the dentist. Treatment at this stage can include: 

• Deep cleaning under the gums
• Antibiotics
• Gum surgery. 

Although rarely a sign of anything serious, of all oral health conditions, mouth ulcers are the most notably uncomfortable and painful, according to the OHF. Ulcers usually clear up in a week or two and need time to heal. Avoiding things that irritate the ulcer can help a patient to speed up the healing process and reduce any chance of it returning. 

"Often the cause of an ulcer is difficult to diagnose," says Ruth Giles, brand manager for Care at Thornton & Ross. "They can be caused by infection, allergy, or trauma such as brushing teeth too hard, biting the inside of the mouth or burning with hot food or drink. In some cases, there may be a genetic component and patients may describe a family history of mouth ulcers."

Pharmacy teams can offer customers lifestyle advice such as making sure to use a soft-bristled toothbrush, drink cool drinks through a straw, eat softer foods and a healthy, balanced diet. There are also many over the counter (OTC) treatments available to prevent ulcers and promote healthy gums. As Ruth explains: "Mouthwashes containing chlorhexidine are an effective product teams can reach for. Pharmacy staff can recommend these to customers for the maintenance of good oral hygiene, including helping to prevent gum disease, as well as for the treatment of ulcers."

Make sure to refer a patient to a dentist if their mouth ulcer:

• Lasts longer than three weeks
• Keeps coming back
• Grows bigger than usual or is near the back of their throat
• Bleeds or becomes more painful and red as this may be a sign of an infection.

Mouth cancer is when a tumour develops in a part of the mouth. It may be on the surface of the tongue, the inside or the cheeks, the roof of the mouth or the lips of the gums. Although globally, mouth cancer is the sixth most common cancer, in the UK it is much less widespread, accounting for one in every 50 cancers diagnosed. Squamous cell carcinoma is the most common form, making up approximately nine in every 10 cases. 

Symptoms of mouth cancer include: 

• Mouth ulcers that are painful and do not heal within several weeks
• Unexplained, persistent lumps in the mouth or the neck that do not go away
• Unexplained loose teeth or sockets that do not heal after extractions
• Unexplained, persistent numbness or an odd feeling on the lip or tongue
• Sometimes, white or red patches on the lining of the mouth or tongue
• Changes in speech, such as a lisp.

Customers are most at risk if they are over the age of 50, are male, drink excessive amounts of alcohol and smoke. Indeed, it is estimated that heavy drinkers and smokers have 38 times the increased risk of developing mouth cancer than people who neither drink nor smoke. 

If mouth cancer is diagnosed early, a complete cure is often possible in up to nine in 10 cases using surgery alone, according to the NHS. If a patient presents with any of these symptoms, pharmacy staff must make sure to refer them to the pharmacist for further consultation as soon as possible.