Colgate Communication - Reviewing this ‘Dental …...toothpaste to prevent dental caries. Previous slide Next slide Slide 15 13 13 Percentage of five-year-old children with dental

Dental caries -prevention & management

Page notesReviewing this ‘Dental caries prevention and management’ module can count towards one of your CPD entries for revalidation. You may wish to encourage your wider team to also review this module to help improve oral health in the local community you and your team serves.

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Pharmacy teams can help prevent dental caries

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• There are 1.6 million visits to a pharmacy every day in England1

• Opportunity to improve oral health in your community

• Integrating oral health into overall health advice

• Recognition as a primary carer in oral health

1. www.psnc,org.uk/psncs-work/about-community-pharmacy

Page notesThere are 1.6 million visits to a pharmacy every day in England. This means that community pharmacy and their teams are in the perfect position to help improve the oral health of their local community by integrating oral health into overall health advice. This opportunity provides a recognition for community pharmacy as a primary carer in oral health.

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Aim and learning outcomes

Aim:To revisit dental caries and review evidence-based advice for the prevention and management of dental caries in young children, adults and the elderly

Learning outcomes:• Review the latest dental disease data• Understand the latest evidence base for optimising toothbrushing with a fluoride

toothpaste• Be familiar with a unique toothpaste technology for children providing everyday

cavity protection• Understand the evidence-based use of high fluoride toothpastes for the

prevention and management of dental caries

Page notesThis slide shows the aim and intended learning outcomes for this module. Consider how this learning will affect the people using your services including the advice you will give.

At the end of this module you can request a ‘Certificate of Completion’ which will include an opportunity to reflect on this learning and note any action points.

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Dental caries

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• Dental caries results in localised destruction of tooth structure caused by the interaction of bacteria in dental plaque with dietary sugars

• Dental caries can occur throughout life affecting both primary and permanent teeth

• Dental caries is preventable

Image source:Dental Health Unit

Children

Adults

Elderly

Page notesHere we see a selection of different individuals with dental caries.

Dental caries affects all ages; it’s not just a disease of children. Medications and diets containing sugars, poor oral hygiene, dry mouth (Xerostomia) caused by poly-pharmacy or radiation therapy can all contribute to dental caries.

It is important to remember dental caries is not inevitable and is preventable.


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Dental caries requires presence of all three factors

5

Tooth

Plaque Sugars

Dental caries

Page notesFor dental caries to occur you need the presence of a tooth, plaque and sugars (found in the diet, or in a medicine).


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Dental caries - a progressive disease

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Image source: International Caries Classification and Management System (ICCMS)

Page notesDental caries is a progressive disease which caneffect all tooth surfaces. The most vulnerable toothsurfaces are within the pits and fissures and in-between the teeth. In higher risk patients we can also see caries on the root and smooth surfaces (crowns)of the teeth.

The progression of caries is linked to cycles of demineralisation (loss of minerals) and remineralisation (mineral gain).


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Demineralisation – remineralisation cycles

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pH value

5.5

pH value

5.5

Demineralisation (loss of minerals) takes place at pH < 5.5(Red region of the curve)

Remineralisation of tooth enamel takes place above pH > 5.5(Blue region of the curve)

Demineralisation/remineralisation of dentine: Dentine critical level pH >6.5

Page notesBacteria found in dental plaque converts dietary sugars into acids. These acids cause demineralisation (loss of minerals). Saliva neutralises plaque acids causing remineralisation (mineral gain).

Many cycles of demineralisation and remineralisation take place prior to developing dental caries. Early dental caries can be arrested and even repaired without invasive intervention by increasing the net mineral gain during the demineralisation and remineralisation cycles. This slide shows the critical pH level for demineralisation and remineralisation including both enamel and dentine.

Reducing the frequency of sugar reduces the number of times the pH level drops to allow demineralisation to take place. As saliva plays a critical role in promoting remineralisation including acting as a buffer to reduce demineralisation, patients with dry mouth (Xerostomia) or reduced saliva flow are at higher risk of dental caries.1

Reference:1. Villa A. et al, Ther Clin Risk Man.2015;11:45-51.


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Dental caries progression

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1. Early caries

3. Into dentine

Image source: Colgate Dental Health Unit, Manchester, England

Border between enamel and dentine

2.

4.

Page notesHere we are looking at caries progression from a cross sectional view.

Very early dental caries (1) (lesions in the enamel covering the tooth) can be arrested with fluoride. If they are left untreated, they can progress through the enamel (2) into dentine (3) (below the enamel layer). This level of dental caries requires invasive dental treatment.

Early caries appears as a chalky area on the enamel surface of tooth as the surface begins to demineralise. At this stage it is reversible. Topical fluoride as a preventive treatment is most effective at this stage.

Untreated caries progresses rapidly through the dentine reaching the pulp (4). The pulp (containing the nerves and blood vessels) becomes inflamed, and this produces severe persistent pain. Inflammation may then spread to the area around the tooth apex eventually giving rise to a dental abscess, which may be acute or chronic. This is often accompanied by breakdown of the dental hard tissues which may be too extensive to allow restoration of the tooth, leading to the tooth having to be extracted.


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Impact of dental caries

Dental caries has many adverse consequences for the individual, their families and society

• Pain from dental caries can lead to sleepless nights

• Treatment of dental caries may cause poor dental attenders of the future

• Dental caries can impact on general health

Page notesDental caries has many adverse consequences for both the individual, their families and society

• Pain from dental caries can lead to sleepless nights. This can lead to reduced attainment at school and reduced productivity at work

• Treatment of dental caries may cause poor dental attendance due to avoidance, fear and anxiety of visiting the dentist

• Dental caries can impact general health. Impaired chewing can impact diet and perceived appearance of dental caries can lead to a reduction in social interaction, reduced self-esteem and feelings of wellbeing

The high prevalence and recurrent nature of dental caries incurs significant treatment costs for both individuals (patient charges) and society (costs for providing NHS dental services). • Patient charges for adults* for filling(s) and or

tooth extraction £62.101

• Average cost to the NHS of providing filling(s) and or tooth extraction £75.002

* Non-exempt fee-paying adults. Children receive free NHS treatment References:1. www.nhs.uk/common-health-questions/dental-health/what-is-

included-in-each-nhs-dental-band-charge (accessed 10/5/19)2. Based on 3 units of dental activity for band 2 treatments


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Dental caries has many adverse consequences for the individual, their families and society

• Pain from dental caries can lead to sleepless nights

• Treatment of dental caries may cause poor dental attenders of the future

• Dental caries can impact on general health

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Page notesPredictors of increased caries risk include:

• Frequent exposure to sugars in food and drink and medications containing sugar

• Inadequate exposure to fluoride

• Past caries experience

• Past caries experience of primary care giver/siblings

• Patients with periodontal (gum) disease, exposed roots or undergoing orthodontic treatment

• Dry mouth (Xerostomia) – reduced saliva due to medications or cancer treatments. All cancer patients can have a dry mouth caused by chemotherapy or radiotherapy

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Latest dental survey for 5 year olds

Page notes


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Dental health is improving in five-year-old children

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Results of dental surveys of five-year-olds in England from National Child Dental Health surveys and PHE Dental Public Health Epidemiology Programme surveys, 1973 to 2017.

Page notesThis chart shows the level of dental caries in the child population at 5 years of age. Dental caries (decay) is measured as dmft = diseased, missing and filled teeth.

The level of disease in 1973 was an average of 3.25 teeth in children at 5 years of age. The reduction in disease from 1973 to 1983 is attributed to the introduction of fluoride in toothpaste. This reduction then plateaued until 2008 before reducing once again to todays average of 0.8 teeth with dental caries in children at 5 years of age. The reduction from 2008 to 2017 is attributed to the evidence-based advice/interventions introduced in ‘Delivering better oral health: an evidence-based toolkit for prevention’ guidance document.

Please click here to visit Delivering Better Oral Health guidance document.


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https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf

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Percentage of five-year-old children with dental caries(England by region), 2008, 2012, 2015 and 2017

Oral health survey of five-year-old children 2017. A report on the inequalities found in prevalence and severity of dental decay. PHE 2018

Page notesEven though the overall picture is improving with over three quarters of five year old children in England not experiencing dental caries, the burden of disease is high amongst children with experience of dental caries. Some regions within England have much higher levels of disease than the national average. There is also a strong association between levels of deprivation and oral health inequalities, driven by diet and access to dental services.


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Evidence-based prevention for children

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Delivering better oral health: an evidence-based toolkit for prevention (2014) Public Health England

Evidence-based guidelines: DBOH v.3 Page notesDelivering better oral health: an evidence-based toolkit for prevention’ guidance document (DBOH) was first published in 2007 by the Department of Health. It’s now in its third edition and published by Public Health England providing dental teams and healthcare professionals with evidence-based advice and interventions to prevent dental diseases. Summary tables show age specific information.

This chart shows the advice to prevent dental cariesin children 3 - 6 years of age. This advice includeshow to maximise toothbrushing with a fluoridetoothpaste to prevent dental caries.


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• Frequency of toothbrushing

• Concentration (ppm F)

• Volume of toothpaste used

• Spitting, not rinsing

Optimising toothbrushing with a fluoride toothpaste Page notesThese factors maximise the effectiveness of toothbrushing with a fluoride toothpaste and form the bases of the advice to be given to parents and carers. We will look at each one in turn for children up to 6 years of age.


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The fluoride concentration found in saliva 12 hours after brushing last thing at night is comparable

to that found after brushing1-4 hours during the day2

Frequency of toothbrushing with fluoride toothpaste

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1. Delivering better oral health: an evidence-based toolkit for prevention (2014) Public Health England 2. Duckworth et al (2001)3. Marinho et al (2003)

Brushing twice a day reduces caries by a further 14% when compared with once a day3

Brush last thing at night and on one other occasion1

Page notesThe evidence base shows toothbrushing with a fluoride toothpaste should take place last thing at night and on one other occasion. This advice (applicable to all age groups) ensures fluoride is introduced last thing at night when the risk of dental disease is higher due to reduced saliva flow.

The evidence base also shows brushing twice daily with a fluoride toothpaste reduces dental caries by a further 14% compared to once a day.


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1. Delivering better oral health: an evidence-based toolkit for prevention (2014) Public Health England2. Twetman et al. (2003) 3. Marinho et al. (2003)

Fluoride toothpastes are effective in reducing caries in primary teeth2

Toothpaste containing 1450 ppm F- is 10% more effective in preventing

caries than 1000 ppm F-3

Advise the optimum fluoride level in toothpastedependant on age:

0-3 yrs – no less than 1000 ppm fluoride1

3-6 yrs – more than 1000 ppm fluoride1

0-6 yrs+ giving concern – use 1350 to 1500 ppm fluoride1

Concentration of fluoride toothpaste used Page notesThe evidence base shows the optimum level offluoride to be used dependant on age. Childrenunder 3 should use toothpaste containing no less than 1000 ppm fluoride and children aged 3-6 years should use toothpaste containing more than 1000 ppm.

Children aged 0-6 years who are giving cause for concern (higher risk of dental caries) the level of fluoride should be 1350 to 1500 ppm fluoride.


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Volume of fluoride toothpaste used

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The amount of toothpaste applied is not associated with the benefits of fluoride toothpaste. It is to prevent fluorosis in children aged 6 years and younger

• Advise the amount of fluoride toothpaste to be used:

• Children under 3 years- use a smear1

• Children 3-6 years - use a pea sized amount 1

• Do not let children lick or eat fluoride toothpaste

1. Delivering better oral health: an evidence- based toolkit for prevention (2014) Public Health England

Smear

Pea sized

Page notesIt is important to advise the correct amount of toothpaste to be used for children up to 6 years of age to reduce the risk of fluorosis due to toothpaste ingestion.


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Spitting, not rinsing

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Reported behaviour Increment2

Use a beaker (small volume) 6.9Head under tap 5.8Use hand (small volume) 5.5

1. Delivering better oral health: an evidence- based toolkit for prevention (2014) Public Health England 2. Chester (1992)

Advise ‘spit, don’t rinse’ after brushing with fluoride toothpaste1

Page notesRinsing immediately after toothbrushing washes thefluoride protection away. This slide shows the increase in dental caries on reported rinsing behaviour with water. It demonstrates less water used on rinsing means less caries.

The evidence base advises ‘spit, don’t rinse’ after toothbrushing. This advice is appropriate for all age groups including adults. If a mouthwash is used (6 years+ and above) it should be used at a different time to toothbrushing again to avoid washing the fluoride away.


Everyday protection for children

Page notesHow can we provide everyday protection for children beyond a regular fluoride toothpaste?


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Fluoride helps to prevent dental caries by inhibiting demineralisation and promoting remineralisation of the

tooth enamel

Now there is an opportunity to fight the underlying cause of

demineralisation – acid in plaque caused by the breakdown of

dietary sugars

Page notesFluoride helps to prevent dental caries by inhibiting demineralisation and promoting remineralisation of the tooth enamel.

Now there is an opportunity to fight the underlying cause of demineralisation – acid in plaque caused by the breakdown of dietary sugars


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Unique kids' toothpaste formulation

The only children's toothpaste powered by 1450ppm fluoride plus Arginine

Colgate® Maximum Cavity Protection Kids

Page notesColgate® Maximum Cavity Protection Kids 3+Toothpaste has a unique formulation. It is the ONLY kids toothpaste with a Sugar Acid Neutraliser Technology powered by Arginine with 1450ppm fluoride, to directly fight sugar acids in plaque.


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Sugar Acid Neutraliser Technology™, powered by Arginine

Sugar Acid Neutraliser™ is Colgate’s unique technology developed to

deliver maximum cavity protection powered by arginine, a naturally

occurring amino acid

ARGININE• Essential amino acid for cell growth• Naturally found in saliva• Found in diary products• Used in dietary supplements

Page notesSugar Acid Neutraliser™ is Colgate’s unique technology developed to deliver maximum cavity protection powered by arginine, a naturally occurring amino acid.


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1.Cantore M et al. In situ clinical effects of a new dentifrice containing 1.5% arginine and fluoride on enamel de- and demineralisation and plaque

metabolism. *Results from a remineralisation study vs. a regular fluoride toothpaste, both with 1450ppm fluoride

The combination of Sugar Acid Neutraliser™ Technology plus fluoride results in4 X greater remineralisation1*

Page notesThe combination of Sugar Acid Neutraliser powered by arginine and 1450ppm fluoride has been proven to provide 4 x greater remineralisation over a regular fluoride toothpaste.


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4 X greater remineralisation than fluoride alone

In situ Clinical Effects of New Dentifrice Containing 1.5% Arginine and Fluoride on Enamel Demineralisation, Re-mineralisation, and Plaque Metabolism• The results show the addition of 1.5% arginine to a

1450 ppm fluoride toothpaste provides superior efficacy in promoting remineralisation and preventing demineralisation of enamel relative to toothpastes with fluoride alone*1

1.Cantore M et al. In situ clinical effects of a new dentifrice containing 1.5% arginine and fluoride on enamel de- and remineralization and plaque metabolism*Results from a remineralisation study vs. a regular fluoride toothpaste, both with 1450ppm fluoride

Page notesA study showing ‘In situ Clinical Effects of NewDentifrice Containing 1.5% Arginine and Fluorideon Enamel Demineralisation, Re-mineralisation, andPlaque Metabolism’ showed the addition of 1.5%arginine to a 1450 ppm fluoride toothpaste providessuperior efficacy in promoting remineralisation andpreventing demineralisation of enamel relative totoothpastes with fluoride alone*1

This means using Colgate® Maximum Cavity Protection Kids 3+ Toothpaste provides greater protection from dental caries vs using a fluoride only toothpaste.


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Clinically proven efficacy

Results from two clinical studies, each of 2 years duration, involving 12,000 patients:

Support the conclusion that a 1450 ppm Colgate MCP toothpaste + Sugar Acid Neutraliser™ Technology (1.5% arginine)

Delivers up to 20% fewer new cavities in 2 years*1,2

Up to 20% fewer new cavities in 2 years*1,2

* Results from 2 two-year clinical studies vs a regular (1450ppm F) fluoride toothpaste. 1.–Kraivaphan P et al. Caries Res 2013; 47; 582-590. 2. Hu DY et al. 2013. Data on file. Colgate-Palmolive company

Page notesAdditional studies demonstrate that the Colgate® Maximum Cavity protection Kids 3+ toothpaste formulation delivers up to 20% fewer new cavities in a two year period, compared to a regular 1450ppm fluoride toothpaste.

Consider recommending Colgate® Maximum Cavity protection Kids 3+ toothpaste in your pharmacy to provide optimum fluoride protection and fight the underlying cause of demineralisation.


Latest dental surveys for adolescents and adults

Page notes


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Dental caries in permanent teeth - adolescents

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Dental caries experience

• 34% of 12-year olds

• 46% of 15-year olds

Dental health of adolescents is improving however just over 1/3rd of 12-year olds and just under half of all 15-years olds have still experienced dental caries in their permanent teeth

Child Dental Health Survey 2013, England, Wales and Northern Ireland NHS Digital

Page notesThis chart shows the dental health of adolescents is improving yet just over 1/3rd of 12-year olds and just under half of all 15-years olds still have obvious dental caries experience in their permanent teeth.


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Number of adults with no natural teeth declining

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Adult Dental Health Survey, 2009

40%

35%

30%

25%

20%

15%

10%

5%

0%1968

Percentage adults with no teeth (England)

1978 1988 1998 2008

Page notesThe latest Adult Dental Health Survey shows the proportion of edentate adults (those with no teeth at all) in England has also fallen from 28% in 1978 to just 6% in 2009. This means 94% of the population now have ‘some’ teeth.

This study is carried out every 10 years. The 2019 study is currently in field and it is expected that the numbers of adults with no natural teeth will fall even further.


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Adults are keeping more natural teeth throughout life

Adult Dental Health Survey 2009, www.nhs.digital.uk

Page notesThe amount of teeth both retained and functional are also increasing over time.

This means almost all visitors to your pharmacy will benefit from oral care advice to keep their increasing number of retained teeth functional and healthy.


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Ageing population

1. ONS, Mid 2017 population estimate. 2.ONS population projections 2014 3. Laing and Buisson (2016)

There are now over 15m people aged 60 or over – 23% of the

population1

The number of ‘older’ old people is also rising – 3m aged 80 or over half a million of

these are aged 90 or over1

By 2039 it is expected there will be almost 22m people aged 60 or over – more than half as many

again as there are today2

Approximately 416,000 people live in care homes. This is 4% of the population aged 65

years and over, rising to 16% of those aged 85 or more3

Page notesOur ageing population is increasing and the number of our ‘older’ old people is also rising. There are 3 million people aged over 80 and half a million of those are aged 90 or over. This data combined with the previous dental study findings and population estimates show the importance of pharmacy teams being able to offer appropriate oral care advice to all their customers.


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Maintaining healthy functional mouths into old age

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• Age related changes including medication can lead to xerostomia, root caries and recurrent caries

• Decreased manual dexterity can exacerbate these problems by resulting in reduced plaque control

• Systemic illness such as Parkinson’s disease and Alzheimer’s disease can also impact on oral health, by making it more difficult for people to take responsibility for their own oral health through oral hygiene and dietary practices

• Signpost your non dental attending customers to see a dentist for an oral care review. Visit www.nhs.uk/using-the-nhs/nhs-services/dentists/how-to-find-an-nhs-dentist/ to find their nearest NHS dentist

Page notesThis increased requirement into older age does come with some challenges:

• Age related changes can lead to xerostomia, a dry mouth often caused by medication taken for systemic illnesses, root caries (caries effecting the exposed roots of teeth) and recurrent caries

• Decreased manual dexterity can exacerbate these problems by resulting in reduced plaque control

• Systemic illness can also impact on oral health, like progressive neurocognitive impairing illnesses (e.g. Parkinson’s disease and Alzheimer’s disease) making it more difficult for people to take responsibility for their own oral health through oral hygiene and dietary practices

Pharmacists and their teams can help these patients, their family members or carers to feel enabled to manage their oral health practices to ensure optimum oral health ongoing, including signposting non dental attenders to see their dentist for an oral care review.


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Delivering better oral health: an evidence-based toolkit for prevention (2014) Public

Health England

Evidence-based guidelines - adolescents and adults Page notesThe evidence-based guidance found in ‘Delivering better oral health: an evidence-based toolkit for prevention’ recommends dental prescribing of high fluoride toothpastes for adolescents and adults, at increased risk. This higher level of fluoride further increases fluoride availability to prevent dental caries.


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Efficacy of high-fluoride toothpaste

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-100

1020304050607080

0 1000 2000 3000 4000 5000 6000

Carie

s red

uctio

n (%

)

Fluoride concentration (ppm)

Toothpaste fluoride concentration from 0 to 5000 ppm has a linear correlation with anticaries efficacy

Adapted from Tavss et al. Am J Dent 2003;16:369–374.

Page notesThis graph shows a linear relationship between fluoride concentration and caries prevention demonstrating the higher the fluoride concentration the more effective it is at preventing caries.

Colgate® Duraphat® Fluoride Toothpastes offerincreased fluoride availability via daily toothbrushingwhen prescribed by a prescribing healthcare professional.


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Colgate® Duraphat® 2800 ppm Fluoride Toothpaste

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• Prescription-only high-fluoride toothpaste• Listed in the Dental Practitioners Formulary within the BNF as sodium

fluoride 0.619%• For daily use in place of regular toothpaste• Indicated for higher-risk patients aged ≥ 10 years1

1. Delivering better oral health: an evidence-based toolkit for prevention (2014) Public Health England

0.619% sodium fluoride

Page notesColgate® Duraphat® 2800 ppm fluoride toothpaste is available for dental practitioners to prescribe to patients at increased risk of dental caries aged 10 years and over.


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Clinical research – 20% caries reduction on all tooth surfaces

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1. Biesbrock AR et al. Community Dent Oral Epidemiol 2001;29:382-389.

Significantly superior efficacy over regular fluoride toothpaste1

Page notesClinical research shows a 20% reduction in diseased (decayed) , missing (extracted) or filled (restored) surfaces of the teeth for Colgate® Duraphat® 2800 ppm fluoride toothpaste compared to a regular fluoride toothpaste.


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• Prescription-only high-fluoride toothpaste• Listed in the Dental Practitioners Formulary within BNF as sodium

fluoride 1.1%• For daily use in place of regular toothpaste• Indicated for higher-risk patients aged ≥ 16 years1

1. Delivering better oral health: an evidence-based toolkit for prevention (2014) Public Health England

1.1% sodium fluoride

Page notesColgate® Duraphat® 5000 ppm fluoride toothpaste is available for dental practitioners to prescribe to patients at increased risk of dental caries aged 16 years and over, particularly amongst patients at risk from multiple caries (coronal and/or root caries).


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Clinical research – Fissure caries lesions

Schirrmesiter JF et al. Am j Dent 2007;20 212-216

5 times more effective at remineralising fissure caries lesions after 14 days

Page notesPits (surface angles) and fissures (groves) are found on the biting surfaces of teeth. The fissures are vulnerable to dental caries as bacteria collects in the groves and they can be harder to clean than smooth surfaces.

Colgate® Duraphat® 5000 Fluoride Toothpaste remineralises initial fissure caries lesions significantly more effectively than a 1450 ppm F- toothpaste after 14 days use.


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Clinical research – Root caries lesions

Reduces significantly root caries lesion progression

Ekstrand 2008 Gerodontology 2008; 25:67-75

Page notesRoot caries effects the exposed roots of teeth. Roots can be exposed due to the ageing process, gum disease or trauma.

This study show that Colgate® Duraphat® 5000 Fluoride Toothpaste is able to arrest 3 times more root caries lesions that 1450 ppm F- toothpaste after 8 months of use.


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Prescribing for a course of treatment

Patients can be prescribed multiple tubes to ensure they have continued use in line with their recall interval in-between examinations

Page notesFor daily use as stated in each SPC, each tube of Colgate® Duraphat® would last approximately one month. This is the reason you may see multiple tubes on one prescription in line with the patients next recall interval.

Patients can be prescribed multiple tubes to ensure they have continued use in line with their recall interval in-between examinations.

Primary care dentists in England use non electronic FP10 prescription pads. Colgate® support dentists by supplying Colgate® Duraphat® branded prescription stamps. These branded prescription stamps are available for dentists to use as they match the descriptions for Colgate® Duraphat® toothpastes in the Dictionary of Medicine and Devices (dm+d).


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Help prevent dental caries in your local community

• Educate all people visiting your pharmacy about the importance of good oral care, especially if they are at increased risk of dental caries including patients with polypharmacy who may have a dry mouth

• Recommend Colgate® Maximum Cavity Protection Kids 3+ Toothpaste, the onlychildren's toothpaste with Sugar Acid Neutraliser™, powered by Arginine plus 1450ppm fluoride for greater cavity protection

• Encourage patients at increased risk of dental caries to visit their dentist or ask their GP for a prescription of high fluoride toothpaste to accompany any prescribed medications causing a dry mouth

• If a patient has been prescribed a high fluoride toothpaste:• Consider dispensing Colgate® Duraphat® toothpaste to support patient satisfaction and compliance

through consistent product experience and packaging• Dispense enough tubes to support the patient’s course of treatment

Page notesThis module has highlighted how community pharmacists and their teams are in the perfect position to help improve the oral health of their local community by integrating oral health into overall health advice.

These steps summarise how community pharmacy can be a primary carer in oral health and help prevent dental caries in the local community.


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Help prevent dental caries in your local community

• Educate all people visiting your pharmacy about the importance of good oral care, especially if they are at increased risk of dental caries including patients with polypharmacy who may have a dry mouth

• Recommend Colgate® Maximum Cavity Protection Kids 3+ Toothpaste, the onlychildren's toothpaste with Sugar Acid Neutraliser™, powered by Arginine plus 1450ppm fluoride for greater cavity protection

• Encourage patients at increased risk of dental caries to visit their dentist or ask their GP for a prescription of high fluoride toothpaste to accompany any prescribed medications causing a dry mouth

• If a patient has been prescribed a high fluoride toothpaste:• Consider dispensing Colgate® Duraphat® toothpaste to support patient satisfaction and compliance

through consistent product experience and packaging• Dispense enough tubes to support the patient’s course of treatment

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Please click here to claim yourCPD Certificate of Completion

Page notesThank you for taking the time to review this CPD module.

Please click below and share your details to claim your CPD Certificate of Completion.


CLICK HERE

https://www.surveymonkey.com/r/PharmacyCPDModule

https://www.surveymonkey.com/r/PharmacyCPDModule

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Page notes


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Abridged prescribing information

Name of the medicinal product: Duraphat® 2800 ppm Fluoride Toothpaste. Active ingredient: Sodium Fluoride 0.619%w/w (2800 ppm F-). Indications: For the prevention and treatment of dental caries (coronal and root) in adults and children over 10 years. Dosage and administration: Adults and children over 10 years old: Use daily instead of normal toothpaste. Apply a 1cm line of paste across the head of a toothbrush and brush the teeth thoroughly for one-minute morning and evening. Spit out after use; for best results do not drink or rinse for 30 minutes. Contraindications: Individuals with known sensitivities should consult their dentist before using. Not to be used in children under 10 years old. Special warnings and precautions for use: Not to be swallowed. Undesirable effects: When used as recommended there are no side effects. Legal classification: POM. Marketing authorisation number: PL00049/0039. Marketing authorisation holder: Colgate-Palmolive (U.K.) Ltd. Guildford Business Park, Midleton Road, Guildford, Surrey, GU2 8JZ. Recommended retail price: £5.10 (75ml tube). Date of revision of text: January 2015.

Page notes

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Abridged prescribing informationName of the medicinal product: Duraphat 5000® ppm Fluoride Toothpaste. Active ingredient: Sodium Fluoride 1.1%w/w (5000ppm F-). 1g of toothpaste contains 5mg fluoride (as sodium fluoride), corresponding to 5000ppm fluoride. Indications: For the prevention of dental caries in adolescents and adults over 16 years of age, particularly amongst patients at risk from multiple caries (coronal and/or root caries). Dosage and administration: Brush carefully on a daily basis applying a 2cm ribbon onto the toothbrush for each brushing. 3 times daily, after each meal. Contraindications: This medicinal product must not be used in cases of hypersensitivity to the active substance or to any of the excipients. Special warnings and precautions for use: An increased number of potential fluoride sources may lead to fluorosis. Before using fluoride medicines such as Duraphat, an assessment of overall fluoride intake (i.e. drinking water, fluoridated salt, other fluoride medicines - tablets, drops, gum or toothpaste) should be done. Fluoride tablets, drops, chewing gum, gels or varnishes and fluoridated water or salt should be avoided during use of Duraphat Toothpaste. When carrying out overall calculations of the recommended fluoride ion intake, which is 0.05mg/kg per day from all sources, not exceeding 1mg per day, allowance must be made for possible ingestion of toothpaste (each tube of Duraphat 500mg/100g Toothpaste contains 255mg of fluoride ions). This product contains Sodium Benzoate. Sodium Benzoate is a mild irritant to the skin, eyes and mucous membrane. Undesirable effects: Gastrointestinal disorders: Frequency not known (cannot be estimated from the available data): Burning oral sensation. Immune system disorders: Rare (≥1/10,000 to <1/1,000): Hypersensitivity reactions. Legal classification: POM. Marketing authorisation number: PL00049/0050. Marketing authorisation holder: Colgate-Palmolive (U.K.) Ltd. Guildford Business Park, Midleton Road, Guildford, Surrey, GU2 8JZ. Recommended retail price: £7.99 (51g tube). Date of revision of text: February 2015.

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