OTCs Today
Daniel L. Krinsky, RPh, MS
Improper oral hygiene is a direct cause of dental cavities, periodontal disease (gingivitis and periodontitis), halitosis, and some cases of denture-related discomfort. During the COVID-19 pandemic, many people have postponed preventive services such as routine dental exams, which has led to a significant uptick in people with these types of conditions. Fortunately, nonprescription products are available for the prevention of oral diseases, and pharmacists can educate the public about their proper use.
Normal salivary gland function promotes good oral health in several ways, including providing lubrication, facilitating removal of microorganisms, neutralizing the acidic environment caused by carbohydrate fermentation, and supporting tooth enamel. Dental cavities, or caries, remain a major public health concern.
Strategies that have been successful in reducing cavities include fluoridation of the municipal water supply, fluoride-containing toothpastes, proper brushing, flossing, and mouth rinses. Those at increased risk of developing cavities include patients who use tobacco products or frequently use alcohol, as well as patients with poor oral hygiene, xerostomia (dry mouth), diabetes, or gum tissue recession that exposes root surfaces. Many of these can be addressed through pharmacist counseling and use of certain over-the-counter products.
While not considered “traditional” over-the-counter products, pharmacies do stock many products that are beneficial for oral health, which is an important aspect of overall health. Some plaque-removal devices include toothbrushes, dental floss, oral irrigating devices, and specialty aids.
To ensure the health of teeth and gingival tissues, the American Dental Association (ADA) recommends brushing at least twice daily and flossing at least once daily. ADA also recommends patients replace their toothbrush every 3 to 4 months.
Dental flossing is the most widely recommended method of removing dental plaque from proximal tooth surfaces that are not adequately cleaned by toothbrush alone.
Oral irrigators, also known as water flossers, work by directing a high-pressure stream of water through a nozzle to the tooth surface. Such devices, however, remove only a minimal amount of plaque from tooth surfaces; therefore, an irrigating device cannot be viewed as a substitute for a toothbrush, dental floss, or other plaque removal devices.
When recommending a nonprescription fluoride mouth rinse, it is important to ensure supervision of children’s use and to prevent excessive fluoride use through multiple products.
Regular use of a mouth rinse with plaque or calculus control properties is indicated as an adjunct to proper flossing and toothbrushing with fluoride toothpaste. Various alcohol-containing and alcohol-free products are available. Antiseptic mouth rinses have demonstrated effectiveness in reducing plaque and gingivitis.
Gingivitis results from the accumulation of supragingival bacterial plaque. While reversible, if left untreated, it may advance to chronic destructive periodontal disease, or periodontitis. Because prevention of gingivitis depends on calculus prevention and plaque control, the same measures described for prevention of cavities pertain to gingivitis.
Halitosis, or bad breath, may involve systemic and oral conditions and often arises from volatile sulfur compounds (VSCs), which can be produced by breakdown of food debris left in the mouth or systemic conditions in which VSCs are eliminated in exhaled air.
Prevention involves removal of plaque and prevention of calculus formation as described for prevention of cavities. Brushing both the teeth and tongue and use of a tongue-cleaning device (e.g., a tongue blade) may be effective in reducing/eliminating the odor.
Hygiene-related denture problems can manifest as pain along the gingival ridge under a denture prosthesis or inflammation of the oral tissue in contact with a removable denture.
Poor denture hygiene contributes to fungal and bacterial growth that may cause aesthetic and clinically relevant oral disease. Removing plaque with specialty brushes and cleaning at least daily with specially formulated products will in many cases prevent these complications.
Those with symptoms of toothache (e.g., pain with or without chewing, localized swelling, hot or cold sensitivity, fever, or headache) or bleeding, swelling, or reddened gums are not candidates for self-care and should be referred to their oral health specialist.