2 Unit 3 Giving Health AdviceSmile4life Unit 3 Giving Health Advice

3 Smile4life: Unit 3 - Learning Outcome To be competent in giving basic health advice on diet, smoking, alcohol consumption, drugs and methadone use.

4 Why is Oral Health so Important?It is widely accepted that oral health conditions share ‘common risk factors’ with general health conditions such as cancers, heart disease and obesity. Therefore in order to maintain good oral health, the mouth cannot be isolated from the rest of the body. Adopting behaviours conducive to good oral health will have a positive impact on general health. POOR ORAL HYGIENE – is the main cause of periodontal (gum disease) and is also implicated in dental caries (decay). A diet high in sugar and fat, and low in fibre and essential vitamins, is associated with conditions such as obesity, cancers, heart disease and dental decay. SMOKING is implicated in many diseases, including cancers of the lung, throat and mouth. In addition, smokers are more likely to have coronary heart disease, diabetes and periodontal (gum) disease, as well as other diseases of the soft tissues of the mouth.

5 Homeless Oral Health Survey in Scotland, 2008-2009Health boards involved The aim of the Smile4life qualitative study was to use grounded theory procedures and techniques to analyse the qualitative data obtained from one-to-one interviews with homeless people. The objective was to identify the main issues and problems of homeless people and explore the ways in which they managed or resolved these issues. The findings will provide an insight into, and thus foster an understanding of, the lives of homeless people in Scotland and their oral health concerns. 853 people surveyed. From the sample questioned, their health, health behaviours, oral health status, oral health-related attitudes and behaviours were also similar to other populations of homeless people across Europe

6 Homeless Oral Health Survey in Scotland, 2008-2009The majority of the sample (85%) reported being smokers 63% stated they were taking prescribed medication 31% of the participants stated that they drank alcohol at least once per day. 68% stated that they had used drugs with 236 (29%) stating they were current drug users. This information sets the scene, letting participants recognise the reasons that intervention is necessary. Smoking The average number of cigarettes smoked daily was about 20 with a range of 1 to 120. - men stated that they smoked on average 20 cigarettes per day. - Women reported to smoke on average 15 cigarettes per day. Medication Sixty-three percent of the sample (496 people) stated that they were taking prescribed medication. A total of 472 participants stated the type of medication they were currently taking. The largest proportions of prescribed medication were anti-depressants, methadone, anxiolytics (tranquilizers) and anti-psychotic medication. For the entire sample (853) this meant that 35% of the prescribed medication was for mental ill-health. A total of 564 participants (68%) stated that they had used drugs with 236 (29%) stating that they were current drug users at the time of the survey. One hundred and ninety-one participants (24%) who currently took drugs stated that they were injecting drug users.

7 Total Sugars Intrinsic sugars Extrinsic sugarsFound naturally in whole fruit, less likely to cause tooth decay. Extrinsic sugars Released when fruit is juiced or blended. Added to many foods Non Milk Extrinsic sugars. Sugar (Taken from Guide for trainers) Sugar is present naturally in many foods such as fruit, vegetables and milk. These intrinsic sugars are less likely to damage teeth. The intrinsic sugars found naturally in whole fruit are less likely to cause tooth decay because the sugars are contained within the structure of the fruit. But, when fruit is juiced or blended, the sugars are released and become extrinsic. Once released, these extrinsic sugars can damage teeth, especially if fruit juice is drunk frequently. These are known as non-milk extrinsic sugars and can cause tooth decay. There is no mention of milk extrinsic sugars within the trainers guide, so in the interests of simplicity I left this out.

8 1. Diet Key message Food containing sugar are harmful to the teeth and the intake of these foods should be reduced.

9 Hidden Sugars Glucose Sucrose Lactose Maltose FructoseWords that end in ose are other words for sugar

11 If possible, sugary foods and drinks should be kept to mealtimesIf possible, sugary foods and drinks should be kept to mealtimes. Avoid sugary snacks and drinks between meals or at bedtime. Between meals, healthy, sugar-free snacks are best. If possible, sugary food and drinks should be restricted to mealtimes. Saliva flow increases at this time and reduces the effects of plaque acid on the enamel. ACTIVITY If time allows, participants can fill out the questionnaire on safe and damaging foods for teeth. This gives the trainer an opportunity to explain in a little more detail why certain foods are extrinsic sugars e.g. Dried fruits ; that some foods that it is expected are healthy, contain a lot of sugars and that when it comes to food and drink we have to remember that certain items can also cause erosion.

12 The Eatwell Plate Developed by the food standards agency. Shows the types and proportions of foods needed to make up a well-balanced diet that promotes good health and protects against the common diet related illnesses. Applies to children over 5, young people, adults and vegetarians. The eatwell plate model is based on 5 food groups and shows how much of what is eaten each day should come from each group. This includes everything eaten during the day including snacks. Further information on the food groups is available within the Smile4Life Guide for trainers.

13 2. Smoking Key Messages Smoking damages the mouth, teeth and gums – it can cause tooth loss, and in more severe cases, mouth and throat cancer. Group discussion How can smoking affect oral health? Split participants into groups and ask then to explore this question, giving reasons why they think smoking may have an effect on oral health. Points for discussion Smoking can stain the teeth yellow or brown due to the nicotine and tar content. Smoking can lead to gum disease – Smoking causes the mouth to produce more bacterial plaque, as the gum becomes loose around the teeth this may lead to the destruction of the root through decay, which will lead to tooth loss. Infected gums are less likely to heal properly, because smoking affects blood flow to the gums. This may mask the severity of gum disease, as the gums are less prone to bleeding. (Bleeding and inflammed gums are an early symptom of gum disease. Gum disease progresses more rapidly among smokers in comparison to non smokers. Smoking or chewing tobacco increases the chance of developing mouth and throat cancer. Every year thousands of people die from mouth cancer caused by smoking. (Unit 2 – Oral Cancer)

16 3. Alcohol Key messages Alcoholic drinks can cause dental erosion. Frequent consumption of alcohol can increase the risk of mouth and throat cancer. Drinking and smoking to excess raises the risk of mouth cancer by up to 30 times. Again, Group Discussion How can drinking alcohol affect oral health? Ask groups to think about why this is the case? Most alcoholic drinks contain sugar. Some are acidic and will cause dental erosion by eroding the enamel on the teeth. Drinking over a long period of time means that the teeth are under acid attack for that whole period. Drinking alcohol is the 2nd most important cause of mouth cancer after tobacco. Frequent or excessive alcohol consumption increases the risk of developing mouth cancer. (In Scotland 35% of men and 26% of women consume alcohol in excess of the recommended number of units per week. People who smoke and drink alcohol have the highest risk of mouth cancer. Excessive smoking and drinking raises the risk of mouth cancer by up to 30 times a alcohol aids the absorption of tobacco into the mouth. For non smokers, the amount and the frequency of alcohol consumption are the most important risk factors for mouth cancer.

17 Oral Cancer Risk Factors Smoker Drink Alcohol Take drugs orally

19 How do drugs affect the mouth?Drug users generally have poorer oral health than non users Chaotic lifestyles/ different priorities Poor diet/ sugar cravings Dry mouth Drugs can mask the pain so early decay is not identified.

20 What damage do drugs have on teeth?Cannabis ( Marijuana, Hash) Cannabis affects almost all systems of the body particularly the cardiovascular, respiratory and immune systems Users are also prone to oral infections

21 What damage do drugs have on teeth?Cocaine (Coke, Blow, Snow, Charlie) Users sometimes rub cocaine over their gums. This numbs the gums, accelerating gum recession. Cocaine mixed with saliva creates an extremely acidic solution. The acid erodes tooth enamel.

22 What damage do drugs have on teeth?Ecstasy ( E, ekies Love Drug) Side effects of this drug include grinding, jaw clenching and dry mouth. If these are chewed they are very acidic, which dissolves the enamel.

24 Methadone Key MessagesMethadone hydrochloride is an acid that attacks tooth enamel. Saliva is mouths natural defence against plaque acid attack and helps to reduce tooth decay. Methadone reduces saliva flow, causing a dry mouth. What is methadone? Methadone hydrochloride is a synthesised substance that has similar pharmacological properties to a particular group of drugs often called opiates, opioids or narcotics, e.g. heroin, morphine. Methadone works by binding to receptor sites in the brain to bring about similar effects to other opiates but without the euphoric side effects. Owing to these similar properties, methadone can be used to reduce the cravings from opiates without causing the extreme highs and lows experienced with other opiates, thus making methadone a suitable therapy for treating withdrawal and dependence from opiate addiction. Methadone is typically dispensed as a syrup formulation, which is taken orally once a day and is available in the standard (sugar-containing) formula or a sugar-free variation.

25 Methadone Key messagesAlways rinse the mouth with water after taking methadone. Chewing sugar- free gum after methadone stimulates saliva flow and helps reduce plaque acid in the mouth.

26 What damage do drugs have on teeth?Methadone Methadone hydrochloride is an acid that attacks tooth enamel. Methadone reduces saliva flow, causing a dry mouth. Saliva is the mouth’s natural defence against plaque acid attack and helps reduce tooth decay.

27 Reducing the Risk to Oral HealthDiet Dry Mouth Sugar content Acidity Acidity Diet – It is frequently reported that opiates will directly induce dietary changes which are characterised by a craving for sugary foods. These dietary changes have been linked to dental decay as a consequence of the increased consumption of sugars. High or frequent sugar intake in the diet should be avoided. Dry Mouth – Opiates reduce the flow of saliva, which is the bodys natural defence against acid, leading to dry mouth. Chewing sugar free gum after taking methadone can help stimulate saliva and reduce the chance of tooth decay. Clients can speak to a dentist about other products available to reduce the effects of dry mouth. Sugar Content – some formulations of methadone contain sugar. Brushing teeth twice a day with fluoride toothpaste, and cleaning between the teeth with

28 Smile4life: Unit 3 - Learning Outcome To be competent in giving basic health advice on diet, smoking, alcohol consumption, drugs and methadone use.

29 Questions ?

30 Further reading: Smile4Life Cancer Research UK Food Standards Agency Cancer Research UK Food Standards Agency