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Yesterday, more than 750,000 people were expected to 'take the leap' and get ready to quit smoking as part of No Smoking Day. But the campaign remains as much about the profession as it does about those attempting to quit. No Smoking Day gives the profession the opportunity to recommend tips on how to maintain a healthy mouth and although most patients know that smoking is hazardous to their health, they may not be aware of the many dangers caused by tobacco, such as gum and periodontal disease, or know it is linked to mouth cancer.
Dental Hygienist Michele Trewhella discusses the importance for the profession in being actively involved in smoking cessation.
As a Hygienist I see my role in smoking cessation as crucial. My experience over the last 40 years has given me a good insight into the damage smoking causes to the mouth and its surrounding structures.
When I started my career in the 70s at least 50 per cent of my patients smoked and so did I. Although difficult to admit, to my shame if I had an awkward patient with lots of tobacco stain, I would sneak off afterwards to the staff room for a ciggy.
I stopped when I was 30 thank goodness, but I believe I lost 3 of my molar teeth through smoke damage.
When I say smoke damage, that's exactly what I mean. Obviously the chemicals and nicotine are harmful and carcinogenic. But what occurred to me was that I was essentially barbequing my gums and soft tissues with hot smoke which I sucked in with the power of a Henry Hoover forcing the smoke into the tissue.
As we know smoke rises, so the palate becomes like a kipper - pale and devoid of a blood supply. The intensity of the smoke will hit the upper back molars as it is sucked up. Hygienists will have noticed that the gingival palatal tissue surrounding the 6's and 7's in smoker has receded by at least 4-5mm, but not so much the buccal aspect. Perhaps the cheek tissue prevents the infusion of the smoke!
As far as I know there has not been any scientific research into this theory, but one only has to look at the crinkled lined lips of smokers and dehydrated facial skin to acknowledge there is something more to this than just nicotine.
People of my generation grew up with smoking. It was the norm. Indeed for us ladies it was seen as sophisticated - remember the iconic photo with Audrey Hepburn?
What really concerns me is the amount of young people I see smoking.
Rising costs to stave people off the habit means more youngsters have turned to rolling their own. Guys, it's not sophisticated and it's not a good look.
How does this relate to tailor-made cigarettes? Is the tobacco stronger in roll ups? Is there less protection from the filters?
Do they inhale more or less smoke? Again I can't find any research relating to this.
When broaching the subject of smoking with my patients I take a very holistic approach. They don't want to be nagged yet again by another health care professional. They KNOW smoking is bad for them. I am honest about my experience of smoking. I take on board all the other daily stress of their lives. These are people not just mouths with teeth and gums. All I want for them is to keep their health teeth and sanity.
I hope I can help them to understand what the consequences are so they can then make informed decisions. That's all I ask and all I can expect. When I finish treatment I ask patients not to smoke for at least one hour to give the enamel a chance to re-mineralize. I hope to plant the seeds of awareness so they may think about stopping. It's a start.
Like weight loss and many other addictive problems, patients have to want to stop. We mustn't tell them off or the shutters will come down and they probably won't return.
As for me I wouldn't even dare have one again. It might seem such a good idea at a party with a glass of merlot, but two weeks later you're standing in the corner shop saying "Twenty Bensons Please".
The term "smoking gun" was originally, and is still primarily, a reference to an object or fact that serves as conclusive evidence of a crime or similar act. How apt!
Michele Trewhella EDH , cert FE
Did you clean your teeth this morning? Will you clean your teeth before you go to bed tonight? There are some people that won't say yes to those questions because they rely on others to deliver their care, are perhaps unconscious, or fed through the stomach (nil by mouth), have mental health problems (dementia) or drug and alcohol dependent and need to get their 'fix' from a local high street pharmacy.
Merchandise that can deliver good mouth care which is available over the counter today may not be as effective as clinically proven products meeting specific needs for those people more susceptible to erratic mouth care delivery.
One of those conditions is dry mouth, clinically known as Xerostomia.
Many people are aware of the problem but don't realise there are solutions to dry mouth. Often they feel it is 'something they have to live with' following a course of treatment or medication. The first choice of care for dry mouth is water, but it very short lived and doesn't adhere to the mouth to give significant relief.
A dry mouth is acidic. So teeth can start to rot very quickly if the mouth isn't put back to a normal pH. The pH of saliva is between 6 and 7.4.
So an acidic mouth leads to bad breath, tooth loss, gum disease and problems with dentures amongst other things.
Patients who wear dentures will have additional problems, primarily retention of their appliances. Absence of saliva may also result in obvious friction between the dentures and the oral mucosa. The use of proprietary fixatives and liners can be helpful, and one of the specialist moisturising gels, designed for xerostomics, may reduce symptoms. Daily cleaning of the prosthesis is essential.
To aid the retention of dentures in patients with a dry mouth, an adhesion, rather than a fixative is advised. Secure (available from www.dentocare.co.uk) is easy to apply and very long lasting.
About 75% of people suffering with a dry mouth do so as a result of the side effect of drugs. Really common drugs like anti-depressants are widely prescribed and create a really dry mouth. Equally there are seasonal conditions like hay fever which result in the purchase of anti-histamine as people suffering with the condition will self-diagnose their problem.
Conditions like rheumatoid arthritis cost the NHS £560 million a year with around 580,000 people in England having the disease and another 28,000 being diagnosed annually.
Patients often suffer depression as a result and as there are few psychological services for them; so they resort to GP's for anti-depressants.
The Journal of Advances in Clinical Neuroscience and Rehabilitation state that there are up to 10 million people have dry mouth in the UK.
75% of people over 65 years take at least one medication, with 30% of this category suffering from a dry mouth.
Everyone produces 1.5 litres of saliva a day slowing to virtually no flow at around 4am (assuming normal sleeping pattern) so this often why people can wake feeling the need to drink water.
Another common mouth condition is oral thrush with hundreds of thousands of people diagnosed each year. This is most common in new born babies, denture users, adults with diabetes or other metabolic disturbance, people with a dry mouth relating to side-effects of their medication (e.g. anti-psychotics) or medical conditions (e.g. Sjogrens Syndrome), people undergoing antibiotic or chemotherapy treatment, people prescribed oral steroid medication or steroid metered dose inhalers, drug users, people with poor nutrition, people with an immune deficiency.
8 to 10% of over 50's suffer from swallowing difficulties, while in elderly homes that grows to 40% with as many as 87% experiencing difficulty with eating meals. There are over 21,500 care homes, 4,500 nursing homes across England.
Over 700,000 people suffer from dementia in the UK and those in advanced stages will be less compliant to mouth care and therefore much more prone to oral thrush and a dry mouth as a result of commonly prescribed drugs for them.
Most long term degenerative diseases will also result in swallow difficulties and problems with eating and mouth care. One in 500 people, around 120,000 individuals, have Parkinson's while 100,000 people have been diagnosed with MS in the UK.
The World Health Organisation (WHO) defines long term conditions (also called chronic conditions) as health problems that require on-going management over a period of years or decades. This includes a wide range of health conditions including non-communicable diseases (e.g. cancer and cardiovascular disease), communicable diseases (e.g. HIV/AIDS), certain mental disorders (e.g. schizophrenia, depression), and on-going impairments in structure (e.g. blindness, joint disorders). According to the Department of Health, there are seventeen and a half million people in the country living with a long term condition.
Around 300,000 people are diagnosed with cancer every year in the UK with millions continuing to live with cancer for many years following treatment. Some treatments may leave a patient with a dry mouth for the rest of their life.
And of course quality of life is absolutely paramount.
The BioXtra provides a complete all round solution to mouth care. The toothpaste and mouthrinse delivers good mouth care preventing oral thrush, which the lozenges and chewing gum stimulate saliva - and the chewing gum doesn't stick to dentures while the spray gel and moisturising gel gives immediate long term relief for a dry mouth.
Even ordinary complaints like snoring, mouth breathing or a common mouth ulcer in fit and healthy people can cause a dry mouth and be painful to clean.
The BioXtra range should be used as part of the everyday routine of cleaning and can be used as a normal regime and not treated as a special treatment that can only be prescribed or used for a short period of time.
BioXtra helps to prevent the formation of ulcers, candidiasis and other infections because it recreates a healthy mouth environment.
The range has natural ingredients and doesn't have harsh detergents like foam (SLS Sodium Lauryl Sulphate) and without it does reduce recurrent ulceration by 81%.
BioXtra is also pH neutral and clinically proven to relieve the symptoms of dry mouth in 14 days and there are no known contra-indications with any medicines. For instance it has been demonstrated that after 14 days of using BioXtra there is a 68@ reduction in dryness, 69% improvement in chewing, 71% improvement in swallowing, 53% improvement in speech and 84% reduction in taste disturbance.
None of the BioXtra range contains alcohol and therefore reduces the chances of mouth cancer but does contain Xylitol which decreases the occurrence of caries and gingivitis, has very little flavouring and is clinically proven to disperse biofilm (plaque) bacteria.
Used daily the advanced formulation of the BioXtra products gently eases the sensations of dry mouth, reduces unwanted bacteria and leave the mouth feeling fresh and comfortable throughout the day and night.
The toothpaste has 1500 ppm (parts per million) fluoride which is the highest permitted in the UK to buy over the counter.
It is very mild to reduce any unnecessary pain when brushing and helps with the prevention of bleeding gums.
No rinsing is required so the fluoride will stay on the teeth continuing to deliver care for much longer than normal toothpastes, and with no Sodium Lauryl Sulphate it means there is no foam to restrict the view of the teeth and gums so the brusher can see if there is a source of bleeding.
The mouthrinse doesn't sting and doesn't stain which makes it a very popular alternative to Corsodyl.
It is anti-bacterial, anti-fungal and anti-plaque with 1500ppm fluoride and is also alcohol free so is a gentle almost taste free refreshing mouthrinse which prevents oral thrush.
It also helps prevent bad breath and gets the flora of the mouth back to normal.
The lozenges have a delicate flavour and help to promote saliva by stimulating it through sucking (I had to get the word in somehow).
The chewing action really stimulates saliva flow and is soft textured for easy chewing which action helps to maintain jaw muscles which are particularly useful for the elderly denture wearers, especially as the gum does not stick to plates or dentures and is sugar free.
It is easy to use gel spray which is light weight and easy to carry around for regular relief of dry mouth.
The spray works instantly for between 1 to 2 hours moisture and keeps the mouth in good condition as it also contains 150ppm fluoride.
The spray is effective for day time relief of dry mouth and has a pleasant taste.
This gel is slightly more viscous then the spray and therefore is much longer lasting as a result tends to get used at night time as one application can last up to 8 hours.
It works instantly and has a pleasant taste and is a much better alternative to petroleum jelly for the lips which is oil based whereas the gel is water based.
This is also a good method of securing dentures simply by applying it to the gums and then applying the teeth to secure their position in the mouth.
It also covers and protects mouth ulcers thereby instantly reducing mouth pain.
Head and neck radiation
Long term degenerative diseases such as Parkinson's and MS
Auto immune diseases such as Sjogrens and Lupus
Renal patients - Due to liquid restrictions (often only 500ml of liquid allowed over 24 hours)
PEG fed patients
Nil by mouth
Spinal Cord Injuries
Anyone on high pressure oxygen
Anyone with poor or reduced oral intake
Care for the elderly
Burning Mouth Syndrome (BMS)
Reduced oral intake
Burning Mouth Syndrome
Michele Trewhella, a dental hygienist from Dentistry at Oceana Boulevard in Southampton has been practising since 1974. Throughout her career she’s played a prominent role within her dental team to help detect mouth cancer, something she takes firmly in her stride.
Taking responsibility is a topic that resonates with Michele, as she has the power to single-handedly change someone’s lifestyle ‘Every practice I have worked in has always had a big focus on checking for suspicious signs,’ she said. ‘The holistic approach to treatment I have found has always been the one to produce results. As part of a patient’s initial consult, we perform a thorough soft tissue examination, primarily on the tongue, cheeks and parts of the throat. In my opinion, there’s nothing more valuable we as dentists can do for a patient than catch mouth cancer early.
Throughout her career, Michele picked up one incidence of mouth cancer in 2008, before a spate of three in 2010. It’s always a topic she’s been comfortable talking to the patient about, a step Michele believes commands greater respect. ‘I have always found patients to be incredibly receptive. They feel very well looked after.
If the patient even takes a small bit of responsibility for their actions and regularly attends the dentist, we have a much better chance of catching the disease early. We have the ability to spot it so early it can remove the need for chemotherapy or radiotherapy. ‘Half of the battle is that the symptoms are often painless. People respond to pain by visiting their GP or dentist, a reason I firmly believe mouth cancer claims so many lives.’
Taking responsibility is a topic that resonates with Michele, as she has the power to single-handedly change someone’s lifestyle. As public awareness of the disease is ‘way too low’ according to Michele, it’s little wonder oral cancer lags behind others in terms of development. She told of how mouth cancer will ‘instantly flick a switch in the patient’s world’ about their current lifestyle and changes that need to be made.
‘The first patient I diagnosed was so grateful she changed her lifestyle altogether. It’s a very powerful tool.’ Knowledge of mouth cancer may not have been at the top of the dental team’s agenda in times gone by, according to Michele, but now more are aware of what they’re looking for and what to do if they suspect something isn’t quite right.
Michele said: ‘Now mouth cancer is a big issue within the dental team, it’s easier to approach the subject with patients, it’s easier to spot things that might be suspicious, and it’s also easier to rule out quite common ailments. ‘Cancer may be a really difficult subject for some people, so being able to say “we’re going to send you for another look, just to rule out X, Y and Z” makes a big difference. People need to realise the first port of call really should be the dentist, as we have the tools in order to be thorough about your examination. ‘The mouth is the barometer of good health.
With so many links between oral health problems and general body health, the emphasis has to lie with the dental professionals to catch this disease early and ultimately save lives.”
Have you helped to identify mouth cancer? Contact the British Dental Health Foundation’s PR Department on 01788 539792 or firstname.lastname@example.org to help raise awareness during the campaign and throughout the year.