Guidelines for preventive activities in general practice

Miscellaneous

Oral health

      1. Oral health

Miscellaneous | Oral health 

Good oral health is important for a person’s physical health and wellbeing,1 with the adverse effects of poor oral health extending beyond the teeth and gums of the individual. While tooth decay, periodontal disease and tooth loss1,2 are the most common oral health diseases, poor oral health can cause pain, infection, difficulties with speech and eating, is associated with chronic disease and contributes poor mental health and wellbeing.1,3 Additionally, poor oral health and decay in early childhood is also associated with impaired growth, decreased weight gain, poor school performance and future dental caries.4 Significant barriers to dental care remain in Australia, which also contributes to poor dental health.

Screening

Recommendation Grade How often References
Screening for oral cancer in the general population is not recommended, because of insufficient evidence. Please refer to the Oral cancer chapter for further information. Generally not recommended N/A 5
 
Routine screening for dental caries performed by GPs and their teams in children aged <5 years is not recommended, because of insufficient evidence.  Generally not recommended N/A 4
 
Routine screening examinations for dental caries performed by GPs and their teams in the general population is not recommended. Generally not recommended N/A 6

Case finding

Recommendation Grade How often References
Examination of the mouth and lips in smokers aged >50 years, heavy drinkers or patients that chew tobacco or betel nut. This should include:
  • visual inspection of the face, neck, lips, labial mucosa, buccal mucosa, gingiva, floor of the mouth, tongue and palate
  • palpating the regional lymph nodes, tongue and floor of the mouth.
Refer to an appropriate specialist or dentist where issues or concerns are suspected.
Practice point Opportunistically. 5
 

Preventive activities and advice

Recommendation Grade How often References
Encourage patients to undertake the following preventive activities to avoid tooth decay and periodontal disease:
  • have a good oral hygiene routine (brushing teeth twice a day with a fluoridated toothpaste, with daily flossing)
  • limit sugary food in diet
  • limit soft drinks, sports drinks and alcoholic drinks
  • quit smoking
  • undertake regular dental check-ups
  • use mouth guards for any contact sports.
Assess whether patients are exposed to fluoride in their drinking water. Additional fluoride therapies might be suitable depending on risk – refer to the Guidelines for the use of fluorides in Australia: Update 2019
Practice point N/A 3,5,7,8,9
 
Avoid putting babies and children to bed with a bottle. Practice point N/A 9

Conditions that may require extra preventive care include3:

  • medications and conditions that are known to cause xerostomia (or dry mouth)
  • human immunodeficiency virus (HIV) infection
  • patient belonging to other special populations (listed below).

For guidance on the use of fluoridated toothpaste and fluoridated products for children, please refer to the Guidelines for the use of fluorides in Australia: Update 2019.

Advise pregnant women to visit a dentist for treatment of all active dental decay and periodontal disease. For recommendations, refer to the During pregnancy chapter.

Australia’s National Oral Health Plan 2015–2024 highlights several priority populations, which are the groups that experience the most significant barriers to accessing oral healthcare and the greatest burden of oral disease. They are:1

  • people who are socially disadvantaged or on low incomes, which includes
    • low income and/or receiving some form of government income assistance
    • refugees
    • homeless people
    • some people from culturally and linguistically diverse backgrounds
    • people in institutions or correctional facilities
  • Aboriginal and Torres Strait Islander peoples
  • people living in regional and remote Australia
  • people with additional and/or specialised healthcare needs, including
  • people living with mental illness
  • people with physical, intellectual and developmental disabilities
  • people with complex medical needs
  • frail older people.

Some populations experience significant financial and access barriers to preventive dental care and treatment in Australia. GPs have the opportunity to identify people who may require extra preventive care, support and education

  1. Australian Institute of Health and Welfare. Oral health and dental care in Australia. Cat. no. DEN 231. AIHW, 2023 [Accessed 27 March 2023].
  2. The Royal Australian College of General Practitioners. 2022 RACGP curriculum and syllabus for Australian general practice. RACGP, 2022.
  3. National Aboriginal Community Controlled Health Organisation and The Royal Australian College of General Practitioners. National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. 3rd edn. RACGP, 2018.
  4. Chou R, Pappas M, Dana T, et al. Screening and interventions to prevent dental caries in children younger than age five years: A systematic review for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality (US), 2021. Available at: [accessed 27 March 2023].
  5. Olson C, Burda B, Beil T, et al. Screening for oral cancer: A targeted evidence update for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality (US), 2013 [accessed 27 March 2023].
  6. US Preventive Services Task Force. Oral health in adults: Screening and preventive interventions. Final recommendation statement. USPSTF, 2023 [Accessed 27 October 2023].
  7. Do LG, Australian Research Centre for Population Oral Health. Guidelines for use of fluorides in Australia: Update 2019. Aust Dent J 2020; 65(1):30–38. doi: 10.1111/adj.12742.
  8. The Australian Dental Association. Guidelines for the fabrication, use and maintenance of sports mouthguards. 5th edn. ADA, 2022 [Accessed 13 April 2024].
  9. Welti R, Chinotti M, Walsh O, et al. Oral health messages for Australia: A national consensus statement. Aust Dent J 2023;68(4):247–54. doi: 10.1111/adj.12973.
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