Dental decay and gum disease

Also called Tooth decay, Periodontal disease, Gingivitis, Toothache

Almost entirely preventable, and the leading reason children in England are admitted to hospital.

What it is

Tooth decay is the most common reason children aged 6 to 10 in England are admitted to hospital, for extractions under general anaesthetic. That fact alone should end any argument about whether oral health belongs in a health library.

Decay happens when bacteria in plaque turn sugar into acid that dissolves enamel. Gum disease happens when plaque inflames the gums, and untreated it destroys the bone holding teeth in place.

Both are almost entirely preventable, and both are dramatically worse in people who depend on others for personal care.

Oral health in care settings is one of the most consistently poor areas of practice. NICE issued a specific guideline about it because inspections found mouth care being skipped routinely.

Signs you might notice

Toothache, sensitivity to hot, cold or sweet.

Visible holes, dark spots, or broken teeth.

Bleeding gums when brushing, which is not normal and is the first sign of gum disease.

Persistent bad breath. Loose teeth. Receding gums.

Facial swelling with pain and fever, which is a dental abscess and can become life-threatening.

In someone who cannot report pain: refusing food, especially hot or cold, pulling at the face, new distress at mealtimes, or a change in behaviour.

How it can affect day-to-day life

Untreated dental pain is one of the commonest hidden causes of what gets recorded as challenging behaviour in learning disability and dementia services.

Poor oral hygiene contributes directly to aspiration pneumonia, which makes mouth care an infection control measure rather than a cosmetic one.

Dry mouth from medication, xerostomia, accelerates decay dramatically.

Access is a real barrier. NHS dentistry availability has become severely limited in many areas, and people with additional needs face the greatest difficulty.

Supporting someone well

Brush twice a day with fluoride toothpaste, spit and do not rinse. Rinsing washes the fluoride away, and almost everybody does it.

Look in people's mouths daily if you provide personal care. This is the check that finds the problem.

Reduce the frequency of sugar rather than only the amount. Sipping a sugary drink all afternoon does more damage than eating a bar of chocolate at once.

Ask a GP or pharmacist about high-fluoride toothpaste for anyone at high risk.

Ask for a community special care dental service for people who cannot attend a high street practice. These exist and are under-used.

Treat new behaviour change in someone who cannot speak as possible toothache, and get the mouth checked.

Facial swelling with fever needs same-day help.

Where to get help

NHS 111 can help find urgent dental care and an emergency dentist.

Ask the GP for referral to community special care dentistry for anyone with additional needs.

The Oral Health Foundation run a helpline and produce easy-read material.