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Gum Disease Threat ‘inflated to sell mouthwash’?

A recent article in The Times newspaper, suggested that the Gum disease threat had been ‘inflated to sell mouthwash’

Here is a copy of the article, together with Dr Galgut’s response:

Gum Disease Threat ‘inflated to sell mouthwash’

[as reported by: Chris Smyth Health Correspondent]

Gum disease is as normal a part of ageing as wrinkles and its threat has been exaggerated to sell mouthwash and expensive treatments, a dental expert has claimed.

Bleeding does not mean teeth will fall out, and proper brushing will cure the problem, said Paul Batchelor, senior lecturer in the dental public health unit at University College London.

Brushing regularly with fluoride toothpaste is the only proven way to protect youe teeth from the more serious problem of decay, he insisted. Expensive scales and polishes offered by dentists to treat gum disease are backed by little evidence and will not help if people are nt looking after their teeth, he argued in the British Dental Journal.

About 10 per cent of people will need treatment for gum problems, but the rate does not vary around the world and is often inherited, suggesting dentists should target smokers and others with real needs, Dr. Batchelor said.

“It’s an overstated problem, if you don’t brush your teeth you will tend to get some inflammation and bleeding, but that will not have the impact that has been suggested,” he said.

“Most people regard wrinkles as simply part of the ageing process. There are some people who rush off to have injections and what we’re seeing with gum disease is that any deviation from the ideal is seen as disease. For many people it is simply part of the ageing process: as you get older, your tissues are not as elastic.”

Defining periodontitis as gaps opening between gums and teeth, encouraged needless treatment of something that may cause no problems, he argued.

“If you define gum disease as a clinical measure alone, everybody has gum disease and you’re going to spend a fortune trying to treat something that actually makes very little difference. As long as the pockets (between teeth) don’t affect your life…what’s the problem? To say it will end with all your teeth falling out if you don’t do something about it, that’s overegging the pudding… You’re creating a problem, and then people will buy something.”

He warned that bleeding gums should not be ignored because they are a sign of poor brushing, which might lead to tooth decay. It was not necessarily true that the condition, known as gingivitis, would automatically lead to more serious problems. “What we do know is many people will have bleeding gums at some point,” said Dr. Batchelor.

Nigel Carter, chief executive of the British Dental Health Foundation, said Dr. Batchelor was “a bit extreme” in dismissing gum disease. “There are two schools of thought on whether gingivitis causes gum disease. The general consensus would not agree with him.”

However, he said: “Do we need to worry about it as much as we do? The answer is possibly there’s too much emphasis and we should be targeting better.” He also agreed that the case for scales and polishes had not been proving, saying: “It is a sad fact that the evidence for a lot of what we do isn’t there.”

Dr. Carter added that fluoride toothpaste was the key to avoiding problems but argued there was no harm in buying brands with antibacterial elements.

Dr Peter Galgut replies:

In point of fact I agree with this article, but not fully.

Mouthwashes are heavily marketed and sold, promoting their advantages and making substantial claims for marketing purposes.  In essence, if you have plaque and debris lodged underneath the gums and you use an anti-septic mouthwash, it simply cannot get down underneath the gums so it does not work!  Also, dental plaque is very good at making a waterproof covering made of a very sticky carbohydrate called dextran.  This protective overcoat prevents mouthwash from killing the bacteria in dental plaque.  As I quoted in an earlier article, mouthwashes are of no benefit in the absence of good oral hygiene.

The key to all of this is good oral hygiene and mouthwashes are not a substitute. Good oral hygiene includes  mechanically brushing the teeth and gums, which breaks up the dextran coat and the structure of plaque, to expose the bacteria and then mouthwashes may have a beneficial effect.  However once you taken the trouble to break up the plaque and its dextran coating, it is effectively and efficiently destroyed by the mouth’s protective natural mechanisms.

So the article is correct, but that is only part of the story.  Once you have brushed and cleaned your teeth meticulously you have millions of plaque bacteria floating around desperately trying to find a new place to settle and regrow.  Using an anti-septic mouthwash as an addition to physically brushing and cleaning the teeth would obviously have some benefit, but this is minimal.

But there are many different mouthwashes for different purposes, for example antiseptic mouthwashes might be useful as a temporary way of managing your mouth if it is sore because of a crop of mouth ulcers or burn from eating food that is too hot and is too sore to brush, or after seeing the hygienist, dentist or periodontist when you want to try and prevent the bacteria from simply re-entering the pockets that they have just been dislodged from..  But these are only temporary patches and mouthwashes should not be used all the time because they kill the “good” bacteria that we need to have in our mouths as well as the “bad” bacteria..

Other mouthwashes have been designed to help people who suffer from dry and burning mouth syndromes, to act as a liquid moisturiser, anti-inflammatory mouthwashes such as Gengigel to reduce pain and inflammation with mouth ulcers and other inflammatory conditions that occur in the mouth, and other mouthwashes are what I call “social” mouthwashes.  These mouthwashes have got strong flavouring, and do very little more than give you a nice fresh mouth if you have an important date or meeting and you want to just make sure that your breath and your mouth is in an optimal state.

So antiseptic mouthwashes are oversold, but should not be written off completely and specialist mouthwashes for special occasions are very useful in helping people who need them.

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