Delivering better oral health: an evidence-based toolkit for prevention
Guideline Title
Delivering better oral health: an evidence-based toolkit for prevention
Recommendations Summary
All Recommendations
Support patient in risk reduction and management.
Support patient in risk reduction and management.
Assess tooth wear using a validated tool (for example Basic Erosive Wear Examination (BEWE)) at the start of any new course of treatment.
Assess tooth wear using a validated tool (for example Basic Erosive Wear Examination (BEWE)) at the start of any new course of treatment.
Maintain good dietary practice in line with the Eatwell Guide including avoiding or minimising sugar sweetened drinks (especially carbonated) and fruit juice and/or smoothies (limited to 150ml per day).
Maintain good dietary practice in line with the Eatwell Guide including avoiding or minimising sugar sweetened drinks (especially carbonated) and fruit juice and/or smoothies (limited to 150ml per day).
Maintain standard oral hygiene practices.Brush teeth at least twice daily: ā¢ last thing at night and on one other occasion ā¢ with toothpaste containing fluoride (appropriate to age ā see dental caries table) ā¢ spitting out after brushing, rather than rinsing with water, to avoid diluting the fluoride concentration
Maintain standard oral hygiene practices.Brush teeth at least twice daily: ā¢ last thing at night and on one other occasion ā¢ with toothpaste containing fluoride (appropriate to age ā see ā¦
Itās not recommended to use vital staining, oral cytology or lightābased detection and/or oral spectroscopy for evaluating lesions for malignancy.
Itās not recommended to use vital staining, oral cytology or lightābased detection and/or oral spectroscopy for evaluating lesions for malignancy.
In line with national referral recommendations, patients should be referred on an urgent or suspected cancer pathway if they have any of the following: ā¢ an unexplained ulceration in the oral cavity lasting for more than 3 weeks ā¢ a persistent and unexplained lump in the neck ā¢ a lump on the lip or in the oral cavity consistent with oral cancer ā¢ a red patch in the oral cavity consistent with erythroplakia ā¢ a red and white patch in the oral cavity consistent with erythroleukoplakia ā¢ persistent
In line with national referral recommendations, patients should be referred on an urgent or suspected cancer pathway if they have any of the following: ā¢ an unexplained ulceration in the ā¦
Obtain an updated medical, social and dental history and perform an intraoral and extraoral visual and tactile examination for all patients at each oral health assessment visit.
Obtain an updated medical, social and dental history and perform an intraoral and extraoral visual and tactile examination for all patients at each oral health assessment visit.
Promote increased consumption of non-starchy vegetables and fruit.
Promote increased consumption of non-starchy vegetables and fruit.
AUDIT-C score of 11 or above, refer to GP or community specialist alcohol service.
AUDIT-C score of 11 or above, refer to GP or community specialist alcohol service.
For those who are pregnant or think they could become pregnant, the safest approach is not to drink alcohol at all, to remove the risk of alcohol-related harm to the baby.
For those who are pregnant or think they could become pregnant, the safest approach is not to drink alcohol at all, to remove the risk of alcohol-related harm to the ā¦
If AUDIT C score is 4 or below, give positive feedback and encourage your patient to keep their drinking at lower risk levels.If score is 5 to 10, give brief advice to encourage a reduction in alcohol consumption and reduce the risk of alcohol harm.Feedback to the patient that their level of drinking is putting them at risk of developing a range of health problems (including cancers of the mouth, throat and breast) and this increases the more you drink and the more frequently you drink. Highligh
If AUDIT C score is 4 or below, give positive feedback and encourage your patient to keep their drinking at lower risk levels.If score is 5 to 10, give brief ā¦
Use the AUDIT-C tool (or similar) to assess a patientās level of risk of alcohol harm by completing 3 consumption questions.
Use the AUDIT-C tool (or similar) to assess a patientās level of risk of alcohol harm by completing 3 consumption questions.
Professional intervention - Identification and Brief Advice (IBA)
Professional intervention - Identification and Brief Advice (IBA)
Refer patients who want to quit to specialist support services.
Refer patients who want to quit to specialist support services.
If someone uses smokeless tobacco, ensure they are aware of the health risks and provide very brief advice.
If someone uses smokeless tobacco, ensure they are aware of the health risks and provide very brief advice.
Ask patients if they use smokeless tobacco, using the names that the various products are known by locally. It may be helpful to show a picture of what the products look like (Chapter 11).
Ask patients if they use smokeless tobacco, using the names that the various products are known by locally. It may be helpful to show a picture of what the products ā¦
Acknowledge that e-cigarettes may be helpful for some smokers for quitting or reducing smoking.
Acknowledge that e-cigarettes may be helpful for some smokers for quitting or reducing smoking.
Act on patient response: ā¢ refer people who want to stop smoking to local stop smoking support, preferably where behavioural support and prescribed stop smoking medicines are available.
Act on patient response: ā¢ refer people who want to stop smoking to local stop smoking support, preferably where behavioural support and prescribed stop smoking medicines are available.
Explain that a combination of behavioural support and varenicline, or short-acting with long-acting Nicotine Replacement Therapy, are likely to be most effective.
Explain that a combination of behavioural support and varenicline, or short-acting with long-acting Nicotine Replacement Therapy, are likely to be most effective.
At every opportunity, ask patients if they smoke and record smoking status (smoker, ex-smoker, never smoker).
At every opportunity, ask patients if they smoke and record smoking status (smoker, ex-smoker, never smoker).
Professional intervention - Very Brief Advice (VBA)
Professional intervention - Very Brief Advice (VBA)
For patients who use medications that cause dry mouth or gingival enlargement: ā¢ explain oral health findings and risk related to medication ā¢ assess and discuss clinical management
For patients who use medications that cause dry mouth or gingival enlargement: ā¢ explain oral health findings and risk related to medication ā¢ assess and discuss clinical management
For patients with diabetes: ā¢ explain risk related to diabetes; ask about HbA1c (glycated haemoglobin) levelsā¢ assess and discuss clinical management.
For patients with diabetes: ā¢ explain risk related to diabetes; ask about HbA1c (glycated haemoglobin) levelsā¢ assess and discuss clinical management.
Patients with diabetes should try to maintain good diabetes control as they are: ā¢ at greater risk of developing serious periodontitis andā¢ less likely to benefit from periodontal treatment if the diabetes is not well controlled
Patients with diabetes should try to maintain good diabetes control as they are: ā¢ at greater risk of developing serious periodontitis andā¢ less likely to benefit from periodontal treatment if ā¦
Ask, Advise, Act: at every opportunity, ask patients if they smoke and record smoking status, advise on the most effective way of quitting and act on patient response, such as refer to local stop smoking support.
Ask, Advise, Act: at every opportunity, ask patients if they smoke and record smoking status, advise on the most effective way of quitting and act on patient response, such as ā¦
Advise best methods for self-care plaque control, both toothbrushing and interdental cleaning.
Advise best methods for self-care plaque control, both toothbrushing and interdental cleaning.
Attend for regular checks of the health of gum and bone around implants.
Attend for regular checks of the health of gum and bone around implants.
Clean around and between implants carefully with interdental aids and toothbrushes.
Clean around and between implants carefully with interdental aids and toothbrushes.
Dental implants require the same level of oral hygiene and maintenance as natural teeth.
Dental implants require the same level of oral hygiene and maintenance as natural teeth.
Assess patientās preferences for interdental plaque control: ā¢ decide on appropriate interdental aids ā¢ demonstrate methods and types of aidsā¢ assess plaque removal abilities and confidence with aidsā¢ patient sets goals for interdental plaque control
Assess patientās preferences for interdental plaque control: ā¢ decide on appropriate interdental aids ā¢ demonstrate methods and types of aidsā¢ assess plaque removal abilities and confidence with aidsā¢ patient sets ā¦
Interdental plaque control: ā¢ clean daily between the teeth to below the gum line before toothbrushingā¢ where there is space for an interdental or single-tufted brush, this should be used ā¢ for small spaces between teeth, use dental floss or tape
Interdental plaque control: ā¢ clean daily between the teeth to below the gum line before toothbrushingā¢ where there is space for an interdental or single-tufted brush, this should be used ā¦
Assess patient, parent or carerās preferences for plaque control: ā¢ decide on manual or powered toothbrush ā¢ demonstrate methods and types of brushes ā¢ Assess plaque removal abilities and confidence with brushing ā¢ Patient sets goals for toothbrushing for next visit
Assess patient, parent or carerās preferences for plaque control: ā¢ decide on manual or powered toothbrush ā¢ demonstrate methods and types of brushes ā¢ Assess plaque removal abilities and confidence ā¦
For people with extensive inflammation, start with toothbrushing advice, followed by interdental plaque control.
For people with extensive inflammation, start with toothbrushing advice, followed by interdental plaque control.
Correct factors that impede effective plaque control including supra and subgingival calculus, open margins and restoration overhangs and contours, which prevent effective plaque removal.
Correct factors that impede effective plaque control including supra and subgingival calculus, open margins and restoration overhangs and contours, which prevent effective plaque removal.
Use behaviour change methods with oral hygiene instruction.
Use behaviour change methods with oral hygiene instruction.
Advise best methods of plaque removal to prevent gingivitis and achieve lowest risk of periodontitis and tooth loss.
Advise best methods of plaque removal to prevent gingivitis and achieve lowest risk of periodontitis and tooth loss.
Around orthodontic appliances and bridges, plaque control should be undertaken using the aids suggested by the dental professional.
Around orthodontic appliances and bridges, plaque control should be undertaken using the aids suggested by the dental professional.
ā¢ use a small toothbrush head, medium texture
ā¢ use a small toothbrush head, medium texture
Toothbrushing and toothpaste: ā¢ brush gum line and each tooth at least twice daily (last thing at night or before bedtime and on one other occasion)
Toothbrushing and toothpaste: ā¢ brush gum line and each tooth at least twice daily (last thing at night or before bedtime and on one other occasion)
ā¢ remove plaque effectively using methods shown by the dental team. This will prevent gingivitis (gum bleeding or redness) and reduces the risk of periodontal disease
ā¢ remove plaque effectively using methods shown by the dental team. This will prevent gingivitis (gum bleeding or redness) and reduces the risk of periodontal disease
ā¢ daily, effective plaque removal is critical to periodontal health
ā¢ daily, effective plaque removal is critical to periodontal health
Where a patient is prescribed medication frequently or long term, liaise with medical practitioner to request that it is sugar free.
Where a patient is prescribed medication frequently or long term, liaise with medical practitioner to request that it is sugar free.
For those with obvious active coronal or root caries, consider prescribing 2,800 or 5,000ppm fluoride toothpaste until dental caries is stabilised and risk is reduced.
For those with obvious active coronal or root caries, consider prescribing 2,800 or 5,000ppm fluoride toothpaste until dental caries is stabilised and risk is reduced.
For those with active coronal or root caries, consider recommending or prescribing daily fluoride rinse (0.05% NaF; 230 ppmF, to be used at a different time from toothbrushing) until dental caries risk is reduced.
For those with active coronal or root caries, consider recommending or prescribing daily fluoride rinse (0.05% NaF; 230 ppmF, to be used at a different time from toothbrushing) until dental ā¦
Use a fluoride mouth rinse daily (0.05% NaF; 230 ppmF) at a different time to toothbrushing.
Use a fluoride mouth rinse daily (0.05% NaF; 230 ppmF) at a different time to toothbrushing.
Support toothbrushing where required (for example carer assistance, specialised brush, non-foaming toothpaste).
Support toothbrushing where required (for example carer assistance, specialised brush, non-foaming toothpaste).
Assign a recall interval ranging from 3 to 24 months, based on oral health needs and disease risk.
Assign a recall interval ranging from 3 to 24 months, based on oral health needs and disease risk.
Minimise the amount and frequency of consumption of sugary food and drinks.
Minimise the amount and frequency of consumption of sugary food and drinks.
Brush teeth at least twice daily:ā¢ last thing at night (or before bedtime) and on at least one other occasionā¢ with toothpaste containing 1,350 to 1,500ppm fluorideā¢ spitting out after brushing rather than rinsing with water, to avoid diluting the fluoride concentration
Brush teeth at least twice daily:ā¢ last thing at night (or before bedtime) and on at least one other occasionā¢ with toothpaste containing 1,350 to 1,500ppm fluorideā¢ spitting out after ā¦
Where a child or young person is prescribed medication frequently or long term, liaise with medical practitioner to request that it is sugar free.
Where a child or young person is prescribed medication frequently or long term, liaise with medical practitioner to request that it is sugar free.
For those 16 years and above with active caries, consider prescribing either 2,800ppm or 5,000ppm fluoride toothpaste until dental caries risk is reduced.
For those 16 years and above with active caries, consider prescribing either 2,800ppm or 5,000ppm fluoride toothpaste until dental caries risk is reduced.
For those 10 years and above with active caries, consider prescribing 2,800ppm fluoride toothpaste until dental caries risk is reduced.
For those 10 years and above with active caries, consider prescribing 2,800ppm fluoride toothpaste until dental caries risk is reduced.
For those 8 years and above with active caries, consider recommending or prescribing daily fluoride mouth rinse (0.05% NaF; 230ppm F), to be used at a different time from brushing, until dental caries risk is reduced.
For those 8 years and above with active caries, consider recommending or prescribing daily fluoride mouth rinse (0.05% NaF; 230ppm F), to be used at a different time from brushing, ā¦
Apply fluoride varnish to teeth 2 or more times a year (2.26% NaF).
Apply fluoride varnish to teeth 2 or more times a year (2.26% NaF).
Apply resin sealant to permanent teeth on eruption.
Apply resin sealant to permanent teeth on eruption.
Use a fluoride mouth rinse daily (0.05% NaF; 230 ppmF) at a different time to brushing.
Use a fluoride mouth rinse daily (0.05% NaF; 230 ppmF) at a different time to brushing.
Parent or carer to assist and supervise toothbrushing if required.
Parent or carer to assist and supervise toothbrushing if required.
Assign a recall interval within the range of 3 to 12 months based on oral health needs and disease risk.
Assign a recall interval within the range of 3 to 12 months based on oral health needs and disease risk.
Apply fluoride varnish to teeth 2 times a year (2.26% NaF).
Apply fluoride varnish to teeth 2 times a year (2.26% NaF).
Brush teeth at least twice daily (with assistance from parent or carer if required):ā¢ last thing at night or before bedtime and on at least one other occasionā¢ with toothpaste containing 1,350 to 1,500 ppm fluorideā¢ spitting out after brushing rather than rinsing with water, to avoid diluting the fluoride concentration
Brush teeth at least twice daily (with assistance from parent or carer if required):ā¢ last thing at night or before bedtime and on at least one other occasionā¢ with toothpaste ā¦
Assign a shortened recall interval based on dental caries risk.
Assign a shortened recall interval based on dental caries risk.
Investigate diet and assist adoption of good dietary practice in line with the Eatwell Guide.
Investigate diet and assist adoption of good dietary practice in line with the Eatwell Guide.
Where the child is prescribed medication frequently or long term, liaise with medical practitioner to request that it is sugar free.
Where the child is prescribed medication frequently or long term, liaise with medical practitioner to request that it is sugar free.
Apply fluoride varnish (2.26% NaF) to teeth 2 or more times a year.
Apply fluoride varnish (2.26% NaF) to teeth 2 or more times a year.
For children taking medication frequently or long term, choose or request sugar-free medicines if possible.
For children taking medication frequently or long term, choose or request sugar-free medicines if possible.
Use toothpaste containing 1,350 to 1,500 ppm fluoride.
Use toothpaste containing 1,350 to 1,500 ppm fluoride.
Apply fluoride varnish (2.26% NaF) to teeth 2 times a year.
Apply fluoride varnish (2.26% NaF) to teeth 2 times a year.
Minimise amount and frequency of consumption of sugar-containing food and drinks.
Minimise amount and frequency of consumption of sugar-containing food and drinks.
Teeth should be brushed by a parent or carer. As the child gets older, a parent or carer should assist them to brush their own teeth:ā¢ on all tooth surfacesā¢ at least twice a dayā¢ last thing at night (or before bedtime) and on at least one other occasionā¢ with toothpaste containing at least 1,000 ppm fluorideā¢ using a pea-sized amount of the toothpasteā¢ spitting out after brushing rather than rinsing, to avoid diluting the fluoride concentration
Teeth should be brushed by a parent or carer. As the child gets older, a parent or carer should assist them to brush their own teeth:ā¢ on all tooth surfacesā¢ ā¦
Assign a recall interval ranging from 3 to 12 months based on oral health needs and disease risk.
Assign a recall interval ranging from 3 to 12 months based on oral health needs and disease risk.
Avoid sugar-containing foods and drinks at bedtime when saliva flow is reduced and buffering capacity is lost.
Avoid sugar-containing foods and drinks at bedtime when saliva flow is reduced and buffering capacity is lost.
Use sugar-free versions of medicines if possible.
Use sugar-free versions of medicines if possible.
Minimise consumption of sugar-containing foods and drinks.
Minimise consumption of sugar-containing foods and drinks.
Parents or carers should brush their childrenās teeth:ā¢ as soon as they eruptā¢ twice a dayā¢ last thing at night or before bedtime and on one other occasionā¢ with a toothpaste containing at least 1,000 ppm fluorideā¢ using only a smear of toothpaste
Parents or carers should brush their childrenās teeth:ā¢ as soon as they eruptā¢ twice a dayā¢ last thing at night or before bedtime and on one other occasionā¢ with a ā¦
Introduce solid foods (of different textures and flavours) at around the age of 6 months. Sugar should not be added to food or drinks given to babies and toddlers.
Introduce solid foods (of different textures and flavours) at around the age of 6 months. Sugar should not be added to food or drinks given to babies and toddlers.
For parents or carers feeding babies by bottle:ā¢ only breastmilk, infant formula or cooled boiled water should be given in a bottleā¢ babies should be introduced to drinking from a free-flow cup from the age of 6 monthsā¢ feeding from a bottle should be discouraged from the age of 1 year
For parents or carers feeding babies by bottle:ā¢ only breastmilk, infant formula or cooled boiled water should be given in a bottleā¢ babies should be introduced to drinking from a ā¦
Breastfed babies experience less tooth decay and breastfeeding provides the best nutrition for a babyās overall health. Support mothers to:ā¢ breastfeed exclusively for around the first 6 months of a babyās lifeā¢ then continue breastfeeding, while introducing solids from around the age of 6 months
Breastfed babies experience less tooth decay and breastfeeding provides the best nutrition for a babyās overall health. Support mothers to:ā¢ breastfeed exclusively for around the first 6 months of a ā¦