In 2005 the Department of Health published ‘Choosing Better Oral Health: An Oral Health Plan for England’. In this strategy document, it highlighted the considerable overall improvement in dental health in England over the last 30 years, which should in turn bring about radical changes in the way in which dentistry is delivered in this country. This would entail moving away from a service focused mainly on treatment to a more preventive model of care.

The subsequent best practice guidance document, ‘Delivering Better Oral Health – An evidence based toolkit for prevention’, summarised evidence based preventive strategies in general dental practice. First launched by the Department of Health in 2007, this document was sent to all general dental practices, described as an evolving series to constantly refl ect the latest evidence base in prevention, revised in 2009, and currently under review with the third edition expected in 2012.
This toolkit is the result of dental teams requesting clear guidance on the advice they should give their patients, and the actions they should take to prevent disease. The toolkit aims to provide practical, evidence based guidance to help promote oral health and prevent oral disease. It is intended as a reference for all dental professionals throughout dental care services.

The toolkit highlights that all patients, not just those at risk, should be given the benefi t of advice regarding their general and dental health. This guidance lists the advice and actions that should be provided for all patients to maintain good oral health. For those patients at greater risk (eg those with medical conditions, or with evidence of active disease), the guidance is to increase the intensity of the same actions taken for the population at large.

Maintaining good oral health
It is important that the whole dental team, as well as other healthcare workers, give consistent messages and that these messages are up to date and correct. This tool kit lists the advice and actions that should be provided for all patients to maintain good oral health, along with supportive evidence for each statement. The main sections include advice on:

  • Principles of toothbrushing for oral health;
  • Increasing fluoride availability;
  • Healthy eating advice;
  • Identifying sugar-free medicines;
  • Improving periodontal (gum) health;
  • Stop smoking guidance;
  • Assessing alcohol misuse;
  • Prevention of tooth enamel erosion.

Many pharmacy teams may feel they already offer their customers advice across many of these topics. It’s important to note that many pharmacies may also notice an increase in activities through pharmacies driven by dentists acting on this guidance. This is especially true in the area of caries (tooth decay) prevention, as documented in the section: ‘Increasing fluoride availability’. This section provides guidance on how fluoride availability can be increased to improve oral health. This includes application of a fluoride varnish by the dentist topically to the affected or at-risk teeth. In addition, there are topical fluoride products that can be prescribed by a dentist which the patient can have dispensed at their local pharmacy for use at home.

Prescribing high concentration fluoride toothpaste
There are two high concentration fluoride toothpastes listed on the Dental Practitioners’ Formulary, and both of these are classified as Prescription Only Medicines:

  • Sodium fluoride 2800ppm toothpaste is a Prescription Only Medicine indicated for high caries risk patients aged 10 years or over;
  • Sodium fluoride 5000ppm toothpaste is indicated for patients 16 years and over with high caries risk, present or potentially at risk of root caries (cavities on the exposed root surfaces), dry mouth, orthodontic appliances, overdentures and those on a highly cariogenic diet or medication.

Both these toothpastes should be used in place of the patient’s regular toothpaste. Patients aged eight years and above who are at risk of caries may be prescribed a fluoride rinse for daily use in addition to twice daily brushing with toothpaste containing at least 1,350ppm fluoride. They can use sodium fluoride mouthwash 0.05 per cent (225ppm) for daily rinsing.
Prescription of any medicated rinse requires patient compliance. In addition, fluoride rinses should ideally be used at a different time from daily toothbrushing to maximise the topical effect of fluoride, which relates to frequency of its availability.
This guidance document provides dental and pharmacy teams with a framework to work together. Pharmacy teams can actively seek contact with local dental practices to discuss their requirements and preferences to ensure these prescribed products are available in pharmacy when the prescription is presented.

September is Oral Health Month
Oral Health Month is a leading UK campaign for the promotion of improved oral health to the general public and takes place each September. The campaign highlights the benefits of good oral health and is an opportunity to encourage communication between pharmacies and their customers.
The theme for the 2011 campaign is focused on ‘The importance of a good oral care regime for a healthy mouth’, utilising the following messages:

  • Brush twice a day with a fluoride toothpaste, last thing at night, and on one other occasion
  • Just spit after toothbrushing, rinsing washes the fluoride away!
  • Avoid toothbrushing straight after acidic food or drinks to help prevent enamel erosion
  • Avoid sugary snacks and drinks between meals
  • Visit the dentist regularly.

Oral Health Month provides pharmacies with an opportunity to get involved in a nationwide campaign. During 2011 a consumer road show visited major retailers at selected venues throughout the month of September, and dental hygienists and therapists were available to provide oral care advice including the importance of a good oral care regime for a healthy mouth.
Also during Oral Health Month independent pharmacies received a prevention advice wheel utilising the evidence based oral care advice included in the Delivering Better Oral Health guidance document. This prevention advice wheel allows pharmacy teams to provide tailored and appropriate evidence based oral care advice to all their customers.

Pharmacy Show 2011
The entire pharmacy team are invited to come along to our session at the forthcoming pharmacy show being held at the Birmingham NEC. The session entitled ‘Evidence based oral health advice and the pharmacy team’ will run through the ‘Delivering Better Oral Health’ guidance document highlighting how this evidence base can be utilised with customers. This session will run at 1pm on Sunday 9th October and again at 10am on Monday 10th October. Visit the stand to see the oral care product range and how this aligns with the Delivering Better Oral Health guidance. Additional copies of the prevention advice wheel will also be available to collect from the stand.


Reference; Delivering Better Oral Health –An evidence based toolkit for prevention, published by the Department of Health, Second edition July 2009.

Further information
To view the prevention messages in Delivering Better Oral Health please visit: Publications/PublicationsPolicyAndGuidance/DH_102331