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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

11. Oral health

Age 0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 > 80

Good oral hygiene and a diet low in sugar help to prevent dental decay and periodontal disease, and improves oral health in children and adults. There is evidence that the use of fluoride in water, or topically, reduces dental decay in children.1–3 Although there is insufficient evidence to screen for oral cancer, opportunistic examination of the mouth and lips is encouraged in increased risk groups.4

Table 11.1. Oral health: Identifying risk of dental decay, periodontal disease and oral cancer
Who is at risk?What should be done?How often?
Average risk
  • Lower socioeconomic groups with difficulty accessing dental care
  • Elderly (including residential care) 5–7
  • Aboriginal and Torres Strait Islander peoples
  • Rural and remote populations
  • Migrant groups (especially refugees); more information is available at Refugee Health Network
Examination of the mouth, teeth and lips (IV, C)

Education regarding prevention (I, B)

Recommendation of professional or home application of topical fluoride pastes, gels or mouth rinses (I, A)
At least every 12 months (more frequent dental check-ups as determined by dentist and other dental health professionals; Practice Point)
  • People with reduced saliva flow (eg head and neck radiation therapy, Sjögren syndrome, multiple drug therapy including psychotropic medications)8, 9*
  • Smokers aged >50 years, heavy drinkers, patients chewing tobacco or betel nut8, 9*
  • Patients exposed to excessive sunlight (lip cancer)8, 9*
Opportunistic examination of the mouth and lips (Practice Point)8, 9*
* Oral cancer references
Table 11.2. Oral health: Preventive interventions
TestTechnique
Education
  • Advise about the hazards of snacks and sweetened drinks containing high levels of carbohydrate and acid between meals10, 11
  • Advise against the use of baby bottles with any fluid apart from water at night 10, 11
  • Advise patients to brush teeth twice daily with fluoride toothpaste. A small pea-sized amount of low-fluoride toothpaste should be used from 18 months to 6 years of age. Encourage to spit not rinse10, 11
  • Advise patients that adult supervision of tooth-brushing is recommended for children until 8 years of age 12
  • Encourage home use of high-fluoride toothpastes, gels or mouth rinses for children >10 years of age and adults at high risk12
  • Advise the use of dental floss daily to prevent gingivitis and periodontal disease 13
  • Advise the use of mouthguards for contact sports13
  • Advise patients of the risks of smoking, chewing tobacco, excessive alcohol consumption and sunlight exposure 9
  • Recommend regular dental check ups 13
  • Additional advice can be obtained from the findings of a national consensus workshop conducted in 2011, available here
Oral examination
  • Inspect mouth for dental decay, stained, worn or broken teeth, and inflamed or swollen gums14, 15
  • Advise pregnant women to visit a dentist for treatment of all active dental decay and periodontal disease14, 15
  • Inspect mouth for xerostomia (dry mouth). It may present as dry and reddened gums and increased decay rate particularly on root surfaces14, 15
  • ‘Lift the lip’ of children 0–5 years of age for early identification of oral problems (also refer to Chapter 3. Preventive activities in children and young people)14, 15
  • Inspect the oral cavity – buccal mucosa, gums, tongue, floor of mouth and palate (looking for white or red patches, ulceration or induration)14, 15
  • Examine the extra-oral areas – neck lips and facial areas – looking for lumps and swellings 9, 16
Fluoridation
  • Fluoridation of public water supplies has improved dental health and reduced dental decay1,2
  • Approximately 90% of Australians now drink fluoridated water. Details regarding fluoride levels in Australian water supplies and recommended dosages of fluoride are provided here17

Implementation

Health inequity

Oral disease is more prevalent among low socioeconomic groups. Significant financial barriers to accessing dental care remain in Australia. People on low incomes are more likely to delay dental visits and less likely to receive appropriate dental care.18

Private dental insurance is associated with higher rates of dental care, but insurance is less common in low income groups or those in regional or remote locations. People who hold healthcare cards are less likely to receive preventive dental care and more likely to receive extractions when visiting the dentist.18,19 Aboriginal and Torres Strait Islander peoples are at higher risk of poor oral health.20

References

  1. Iheozor-Ejiofor Z, Worthington HV, Walsh T, et al. Water fluoridation for the prevention of dental caries. Cochrane Database Syst Rev 2015;6:Cd010856.
  2. McDonagh MS, Whiting PF, Wilson PM, et al. Systematic review of water fluoridation. BMJ 2000;321(7265):855–59.
  3. World Health Organization. Sugars intake for adults and children. Geneva: WHO, 2015.
  4. US Preventive Services Task Force. The guide to clinical preventive services: Recommendations of the US Preventive Services Task Force. Rockville, MD: USPSTF, 2014. Available at www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/index.html [Accessed 1 November 2015].
  5. National Health and Medical Research Council. Review of water fluoridation and fluoride intake from discretionary fluoride supplements. Canberra: NHMRC, 1999.
  6. Ahovuo-Saloranta A, Forss H, Hiiri A, Nordblad A, Makela M. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev 2016;1:Cd003067.
  7. Sievers K, Silk H. Fluoride varnish for preventing dental caries in children and adolescents. Am Fam Physician 2016;93(9):743–44.
  8. US Preventive Services Task Force. Oral cancer: Screening. Rockville, MD: USPSTF, 2014. Available at www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/oral-cancer-screening1 [Accessed 1 November 2015].
  9. Smith RA, Cokkinides V, Brooks D, Saslow D, Shah M, Brawley OW. Cancer screening in the United States, 2011: A review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin 2011;61(1):8–30.
  10. Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003;1:Cd002278.
  11. Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VC, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2010;1:Cd007868.
  12. Marinho VC, Worthington HV, Walsh T, Chong LY. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2015;6:Cd002280.
  13. National Oral Health Promotion Clearing House. Oral health messages for the Australian public. Findings of a national consensus workshop. Aust Dent J 2011;56(3):331–35.
  14. Department of Health. Evidence-based oral health promotion resource. Melbourne: Prevention and Population Health Branch, 2011.
  15. NSW Health. Early childhood oral health guidelines for child health professionals. Sydney: Centre for Oral Health Strategy, 2014. Available at www.health.nsw.gov.au/policies/gl/2014/GL2014_020.html [Accessed 21 March 2016].
  16. Sugerman PB, Savage NW. Current concepts in oral cancer. Aust Dent J 1999;44(3):147–56.
  17. Neil A. The extent of water fluoridation coverage in Australia. Aust N Z J Public Health 2011;35(4):392–93.
  18. Sanders A. Social determinants of oral health: Conditions linked to socioeconomic inequalities in oral health in the Australian population. Canberra: Australian Institute of Health and Welfare, 2007.
  19. Chrisopoulos S, Harford J. Oral health and dental care in Australia: Key facts and figures 2012. Canberra: AIHW, 2013.
  20. 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. 2nd edn. South Melbourne, Vic: RACGP, 2012.
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