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2017 HCHB_digital

Oral Health Oral health

Oral Health Oral health disorders include bad breath, baby teething problems (see Childhood Pain and Baby Teething), dry mouth, fungal infections (such as oral thrush), gingivitis and periodontal disease, mouth ulcers, sore throat (see Sore Throat) and tooth decay (see Toothache). Bad breath Bad breath – also called halitosis – can occur with abscesses, gingivitis, indigestion or reflux, tooth decay, after eating spicy foods or garlic and when saliva production is low. Check teeth cleaning regimen and consider chlorhexidine mouthwashes. Refer to a dentist or doctor if a more serious underlying problem is suspected. Dry mouth Dry mouth (xerostomia) is due to a lack of saliva. Medications, radiation therapy, dehydration and poorly controlled diabetes are some of the more common causes. If the cause cannot be corrected, saliva substitutes may provide some relief. Oral thrush This usually presents as creamy-white, soft, elevated patches on the tongue or oral palate that can be removed to reveal inflamed mucosa underneath. Pain and soreness are also often present. Commonly seen in babies, oral thrush is usually caused by the yeast Candida albicans. Although it is unusual for adults to get oral thrush, it may occur in people with asthma who fail to rinse their mouths after using steroid inhalers. Immunosuppressed people or people who have a dry mouth, ill-fitting dentures or who have had recent antibiotic therapy, are also more at risk. Anybody presenting with oral thrush should be referred to the pharmacist. Treatment is with oral antifungal mouth gels or liquids. Gingivitis and periodontal disease Swollen and red gums that bleed easily are a sign of gingivitis. If left untreated, gingivitis can progress to periodontitis. Periodontitis is a long-lasting bacterial infection that affects the gums and the bones supporting the teeth, and may ultimately lead to tooth loss. People over the age of 40, who smoke, don’t floss, with certain medical conditions (such TREATMENT OPTIONS Category Examples Comments Mouth ulcer treatments Oral thrush Mouthwashes for gingivitis Dry mouth Products for maintaining or restoring good oral and throat health Oral hygiene Topical analgesics/anaesthetics [GENERAL SALE] eg, Bonjela Mouth Ulcer Gel*, Orased Jel [PHARMACY ONLY MEDICINE] eg, Difflam Mouth Gel, Difflam-C Anti-Inflammatory Antiseptic, Frador*, Medijel* Topical corticosteroids for oral use [PHARMACIST ONLY MEDICINE] eg, Kenalog Dental Paste, Oracort Dental Paste Chemical cauteriser [GENERAL SALE] eg, Oralmedic [PHARMACIST ONLY MEDICINE] eg, miconazole (Daktarin Oral Gel, Decozol Oral Gel), Nystatin (Nilstat Oral Drops) eg, Cepacol, Cepacaine, Chlorhexidine 0.2%, Kiwiherb Manuka, Savacol [GENERAL SALE] eg, Aquae Dry Mouth Spray, Biotene range, Oralube Saliva Substitute, Oral Seven range, Xerostom Range [GENERAL SALE] eg, Air-Lift [SUPPLEMENT] eg, BLIS K12 range, BLIS M18 range, Comvita Oral Spray, Radiance ManukaGuard Honey Lozenges eg, CareDent range, Colgate Total Interdental brushes, MouthWatchers Anti-bacterial Toothbrushes, Piksters Interdental brushes, TePe Interdental brushes, Waterpik range Products with an asterisk have a detailed listing in the Oral Health section of OTC Products, starting on page 253. Contain a topical oral pain reliever or anaesthetic (such as choline salicylate, lignocaine, aminacrine, or benzydamine) to relieve the localised pain associated with mouth ulcers. Chlorbutol is a weak local anaesthetic with antibacterial and antifungal properties. Forms a protective paste over the ulcer to speed healing. Apply after food. Dab onto ulcer and smooth over with saliva. Do not rub in. Single-use treatment that extracts water from the damaged tissue and forms a seal over it, quickly eliminating mouth ulcer pain and aiding healing. Hold dose in the mouth for as long as possible before swallowing. Avoid food and drink for half an hour before and one hour after taking a dose. Do not use Decozol oral gel in babies under six months or people with poor swallowing. Products containing chlorhexidine appear the most effective at reducing plaque and gingivitis, but prolonged use may stain teeth and brown gums. Help to relieve dry mouth (xerostomia) and increase unstimulated salivary flow. Use as often as needed. Air Lift uses oils to eliminate bad breath caused by foods or tobacco. BLIS products restore the balance of naturally occurring bacteria. Natural lozenges containing honey may help to maintain good throat health. Brush teeth twice a day to remove plaque and keep gums healthy. Water jet systems remove food debris and bacteria from where brushing and flossing can’t reach. Interdental brushes help remove plaque and food from between teeth and are an alternative to dental floss. Daily attention to oral hygiene can help reduce tooth decay. PharmacyToday.co.nz A part of your everyday. New Zealand’s premier pharmacy website keeping you up to date between issues. www.pharmacytoday.co.nz Page 112 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Good oral hygiene •• Use a soft toothbrush and brush teeth for two minutes twice a day. •• Brush gently around the back and front of the teeth, including where the teeth meet the gums. •• Change your toothbrush every three months. •• Spit out after toothbrushing, and don’t rinse. A small amount of fluoride toothpaste left around the teeth will help protect them. •• Floss or use an interdental brush daily (minimum three times/week). •• Fluoride mouth rinses may be used in adults and children aged older than six who are at high risk of dental caries (see Toothache). •• Eat a healthy diet and limit sugar intake. •• Avoid sipping sweet drinks for prolonged periods and discourage snacking and grazing throughout the day – teeth need a break! •• Visit your dentist regularly (every six to 12 months) for check-ups. •• Talk to your dentist about taking fluoride supplements or using topical fluoride products if your water supply is not fluoridated. as heart or respiratory disease, malnutrition, diabetes) or who have had gum problems or tooth extractions in the past are more at risk. Certain family groups are also more prone to periodontal disease either due to genetic susceptibility or through transfer from family member to family member of causative bacteria through saliva. It is important to recognise the signs of gingivitis and treat early. The most likely cause of gingivitis is inadequate oral hygiene, and improvement in this (see Good Oral Hygiene text above), in addition to professional treatment, will usually reverse progression of the disease. Refer to a dentist as soon as possible anybody presenting with signs of gingivitis or with more advanced periodontal disease (recognised by gums bleeding without any trauma, loose teeth or pus in between the teeth, persistent bad breath, receding gums) as delays in treatment can result in loss of teeth. Mouth ulcers Mouth ulcers are common and usually occur on the inside of the lips and cheeks, or underneath the tongue. They are usually grey-white in colour, up to 5mm in diameter, very painful, and can occur singly or in clusters. Most appear suddenly and will disappear by themselves within seven to 14 days; however, many people seek OTC medications because of the pain. Although the exact cause of mouth ulcers is unknown, links to stress, mouth trauma (for example, from poorly fitted dentures), nutritional deficiencies (particularly B vitamins, iron and folic acid), hormonal changes, infection and certain medications have been found. Mouth ulcer treatments usually contain topical corticosteroids which improve healing, local anaesthetics to numb the pain, or chemical cauterisers to seal damaged tissue. Spicy or acidic foods may worsen pain and delay healing of mouth ulcers. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Is the person on any medication or are there any ongoing health problems? • Is the mouth ulcer larger than typical, irregularly shaped or relatively painless? • Could the person have oral thrush? • Is the person aged less than 10 years? • Has the mouth problem been present for longer than seven days or persisted despite treatment? • Does the person have any other symptoms (eg, fever)? • Is the condition extensive, persistently bleeds or bleeds spontaneously, or is there swelling or pain? • Have the injuries to the mouth been caused by trauma? • Does the person smoke? • Does the person have any allergies to topical products? Initial assessment Always inspect the mouth if possible to confirm the problem. Many oral health conditions require further input from a pharmacist or dentist (as detailed in each subsection above) and will need to be referred. Where appropriate, encourage regular brushing and flossing and a healthy diet to all customers as maintaining good oral health is the best prevention against gingivitis, periodontal disease and tooth decay. Page 113

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