A collection of all of our favourite blog entries from our publications: Smile, BDNJ and The Probe.

Oral health care: ‘celebrity’ opinion versus the evidence

Oral health care: ‘celebrity’ opinion versus the evidence

By BARRY COCKCROFT, former CDO England...

The culture of celebrity appears to have penetrated the dental profession. The Probe recently received a communication from a PR company that offered to provide advice to readers on tooth brushing, on behalf of its client, one of “the UK’s leading dentists” with “celebrity” status. Of these ten ‘top tips’, only two were 100 per cent accurate or based on evidence and a couple were possibly detrimental to oral health. They were, in reality, the non-evidence-based and personal views of an individual – an unnecessary self indulgence when robust evidence-based information is available in Delivering Better Oral Health (DBOH), which I would suggest this dentist should spend some time reading.
Some of the errors were small but in these days of widespread internet readership could have a significant negative impact on oral health. One of the tips was to “brush twice a day, in the morning and evening” in fact you should brush twice a day, in the morning and last thing at night. Brushing in the evening and then later eating or drinking something containing sugars potentially leaves plaque acid on the surfaces of the teeth all night.
The advice to use a mouthwash after brushing directly contradicts the guidance in DBOH. You should not rinse after brushing. Using a proprietary mouth rinse can improve periodontal health, but should not be done straight after brushing as it reduces the caries reduction action of modern fluoride toothpastes. When we first produced DBOH we came under pressure to revise this element of our guidance but, after reviewing the evidence, our experts advised us that the guidance should not be changed. When I was in practice I used to advise my patients to brush in the morning and last thing at night and to rinse at lunchtime (but that is a personal view!).
Another ‘tip’ was to visit the dentist every six months. This is clearly at odds with NICE guidance; some people will need to see the dentist more often than that but many not that frequently. NICE guidance says that the correct recall interval should be agreed after a discussion between patient and clinician, and that interval should be based on a risk assessment.
The dentist recommends his own ‘natural’ toothpaste (no surprise that he has something to sell) as it contains calcium carbonate and silica, “for a natural experience”. My understanding is that these are the normal substances used in most toothpaste to provide the abrasion required to break down plaque. The PR company confirmed that this ‘natural’ toothpaste was fluoride-free; so, with the product priced at £15 a tube, you can pay ten times the price of a normal toothpaste for something that is sub-optimal in terms of caries reduction.
Finally, there was the suggestion that we should rinse with coconut oil to remove plaque and toxins from between the teeth.
As CDO, I received many queries regarding alternative treatments, but this wasn’t one I’d come across before. I did what many people do in a bid to find out more about something and paid a visit to the internet.
Given the properties attributed to coconut oil online, I’m surprised it’s not available on the NHS. According to the internet, it helps weight loss, kills many harmful bacteria as well as candida, makes us live longer, reduces epilepsy, reduces cholesterol and reduces the symptoms of Alzheimer’s disease, among other things.
I looked a bit further to find reference to teeth and coconut oil. The only scientifically robust reference I could find was from the American Dental Association (ADA), which says that there is not enough evidence to support using it as a tooth-whitening product, especially when there are other proven products available. The ADA’s final comment was that, at best, it was ineffective but at worst it would cause diarrhoea and an upset stomach.
It is so important that the public gets consistent and evidence-based help and advice on improving their oral health – after all, patients play a bigger part in maintaining their own oral health than clinicians. The really worrying thing is that people visiting our information-overloaded internet are unable to distinguish between evidence-based science and the views of genuine experts, and the views of ‘celebrities’ expressing personal opinions that they seek to justify, not by evidence, but by their own, self-perpetuated, ‘celebrity’ status.