As health professionals, pharmacists are key figures in the interdisciplinary health teams that work together monitoring and caring for people with diseases. In the case of oral health, their proximity and accessibility often make them the first professional to whom many patients turn when they need to clarify certain doubts about bleeding gums, sensitivity to heat and cold, dry mouth or halitosis. Hence the importance of their proper training in these areas and the need to foster a close tie with the dental clinic.

Many people walk into the pharmacy with gum complaints that may lead the pharmacist to suspect gingivitis or periodontitis. Bleeding gums, bad breath, extreme tooth sensitivity, tooth mobility, changes in tooth position or the presence of an abscess or phlegmon may indicate the existence of periodontitis, an inflammatory disease that destroys the bone supporting the teeth until they fall out and which poses an additional risk to overall health by increasing the possibility of heart attack, stroke, respiratory disease or preterm birth, and hinder the control of diabetes.

“Pharmacists play an essential role to improve the early diagnosis and prevention of gum disease, as well as to collaborate with dentists in monitoring its evolution,” says periodontist Dr. Neus Carrió, a lecturer in the Periodontics Master’s Degree programme at the International University of Catalonia, who has collaborated with the Spanish Society of Periodontics and Osseointegration (SEPA).

In fact, the first piece of advice on health is often given at the pharmacy. That is why, according to former SEPA chair Dr. Núria Vallcorba, “pharmacists and their teams are essential for providing information about gum disease, and its prevention and treatment”. In her view, “they are exceptional information points, because of the confidence people have in them, because of their qualifications, and because they are widely distributed geographically.”

ESSENTIAL ROLE IN PREVENTION

The prevention of oral disease is necessary to keep teeth nice and healthy and chewing effective, and it is fundamental for good general health; of all good habits for health, effective, regular oral hygiene is key. From this perspective, Dr. Carrió considers that “the propagation of healthy hygiene habits by pharmacists is decisive.”

Dr. Carrió maintains these professionals “can advise on the best resources available to promote periodontal prophylaxis. Pharmacists can offer their customers information about different forms of gum disease and encourage them to seek the necessary dental examinations.”

There is currently a wide variety of products available on the market that help prevent periodontal diseases. Pharmacists are very familiar with oral hygiene products: brushes with soft or medium bristle hardness, small heads to reach rear quadrants; interproximal brushes of different sizes depending on the space between teeth; dental floss and tape; toothpastes or mouthwashes that supply ingredients such as fluoride for cavities or contain components to reduce hypersensitivity, inflammation, or dental stains, to prevent bad breath, etc. But beyond advising on the most appropriate product for each customer, the pharmacist’s recommendation on the need to brush twice a day and have two check-ups a year with the dentist or periodontist is fundamental.

In addition, the therapeutic care given by pharmacy professionals can help with the detection of factors associated with periodontal disease, and besides dispensing the right product, if they suspect that the patient may have periodontal problems, they should recommend a visit to the dentist.

PHARMACISTS AND DENTISTS, WORKING AS A TEAM

Pharmacists have a prominent role in health care. Like other medical specialists, such as cardiologists, endocrinologists or gynaecologists, pharmacists are healthcare professionals who may suspect if a person presents periodontal problems and can recommend a timely visit to the dentist.

As an example, Dr. Carrió states that “if a person comes to the pharmacy because their gums bleed, besides dispensing an oral cleansing product, the pharmacist should be aware that gingival bleeding implies a disease that must be properly diagnosed and that has to be treated by a periodontist.”

Hence the importance of organising informative lectures to establish greater communication between pharmacists and periodontists. Along these lines, Dr. Carrió also proposes “establishing certain gum care recommendations for those who visit the pharmacy, since the pharmacy becomes an essential information point for the patient; and additionally, they can assess whether customers are complying with daily oral care recommendations, if they are getting their recommended dental check-ups and if they present problems with their gums (including bleeding when brushing or red or swollen gums).”

IMPROVING THE PHARMACIST’S TRAINING

Since there has been major progress relating to our knowledge about oral health and there are more and more oral health products on the market, pharmacy professionals need constant training, and dentists and periodontists must help them with that.

“Pharmacists and dentists form a team to secure the best oral health for everyone,” says Dr. Vallcorba. Pharmacists should receive specific up-to-date training from dentists, and likewise, dentists should assist pharmacists by recommending that they dispense products whose efficacy has been scientifically proven, while explaining the difference between the diverse products on the market to their customers.

Customers generally recognise and appreciate that pharmacists do not just sell products, but know them well, know what they are used for, when and how, so they feel guided in the use of the product they have purchased.

DIABETICS AND PREGNANT WOMEN, TARGET POPULATIONS

Although the pharmacist’s work in oral health care covers the entire population, there are at least two groups where their role may be especially relevant: people with diabetes and pregnant women.

It is important for pharmacists to know that periodontal disease is more common and progresses more quickly in poorly controlled diabetics. Diabetes is a risk factor for periodontitis, and diabetics are two to three times more likely than non-diabetics to suffer periodontitis. Diabetics also tend to have an increased number of deep pockets and increased bone loss. In addition, there is an association between the duration of diabetes and the risk of onset of periodontitis, and a dose-response relationship between poorer metabolic control of diabetes and the severity of periodontitis.

“If diabetic patients do not take proper daily care, they should be reminded that this forms part of their control of diabetes, and the importance of regular dental check-ups should be stressed,” says Dr. Carrió, who points out that “the education of those who have diabetes should include the implications of their condition - especially if poorly controlled - on periodontal disease.”

Dr. Vallcorba specifies that pregnant women “should be instructed as early on as possible (ideally, before becoming pregnant) on proper oral hygiene techniques, including interdental hygiene, which should be performed daily as a routine.” If a pregnant woman is suspected of having periodontal problems, she should be referred to a periodontist, especially since poor periodontal health is known to potentially be a risk factor for preterm birth and low birth weight babies. Therefore, “a pregnant woman should be treated for her periodontal problem, or her condition should be properly prevented, before and during pregnancy, particularly in the second trimester,” advises Dr. Vallcorba.