With NHS treatment becoming increasingly scarce, Esther Walker highlights the simple steps you can take to help keep your mouth healthy - and avoid all the pain and expense
Mouthwashes are used for two different reasons: to prevent bad breath and to kill plaque (or prevent its build-up). Mouthwashes became popular in the Sixties after a doctor in Denmark discovered that a chlorhexidine compound could prevent the build-up of dental plaque. Since then, the mouthwash market has capitalised. Most brands contain all sorts of active ingredients that claim to reduce plaque build-up. Many also include such a hefty amount of alcohol that it is possible to fail a breathalyser test after rinsing with them.
"Some of the mouthwashes with fluoride are very good, and there are some fantastic mouthwashes available," Clarke says. "However, you shouldn't make the mistake of thinking that they are a substitute for brushing and flossing. Most mouthwashes are useful for making the breath fresh, which is a good thing - it's all part of the grooming process."
It is generally received opinion that sugar is the worst thing for your pearly whites. It converts in the mouth to acid, which attacks the teeth. " During the Second World War, when sugar and sweets were rationed, the dental health in the country improved enormously," Clarke says. "The population of the island Tristan de Cunha in the South Atlantic had no access to sugar before it was discovered by the West, and they had perfect dental health until they started eating sugar. So it can't be emphasised enough, the impact of sugar on the teeth. And there is sugar in all sorts of unexpected things, like baked beans, breakfast cereals and processed food. A lot of people say that they don't eat any sugar, but what they mean is that they don't eat sweets. There might be a lot of sugar in their diet from hidden sources they aren't aware of."
If you do have a really sweet tooth, the best time to eat sugar is at mealtimes, when you have already been producing a lot of saliva, thus neutralising the acid from the sugar. And if you want to eat an entire bag of toffees, it's less damaging to eat it all at once than over a long period of time.
"Dentists are always the ones telling their children at Easter to eat their eggs all in one go, although that's not necessarily very healthy," Clarke says. The worst thing you can do is eat a series of sweets (sticky ones are the worst because they get stuck between the teeth) in 20-minute intervals, because the pH of your mouth is raised to acidity for 20 minutes after eating something sweet. "Things like apples are technically acidic and contain a fruit sugar, but I would never knock eating apples," Clarke adds.
As well as damaging your nervous system and your wallet, it seems that prescription and recreational drugs can damage your teeth, too.
"There are three reasons why I can see that drug-taking can cause problems with your teeth," Clarke says. "The first is that some drugs, including Ecstasy, dry the mouth out. If there is a lack of saliva then the acid in the mouth isn't neutralised. Second, some drugs can make you crave sugary food - and the combination of sugar and no saliva to neutralise it is bad. Third, if you are taking a lot of recreational drugs, it could just be the case that you're not really in the mood to brush your teeth carefully twice a day.
"But there are also some prescription drugs, such as anti-depressants, that can cause a dry mouth. Sometimes people who get that are recommended to suck polo mints, which is a disaster for their teeth if the polos aren't sugar-free."
Cocaine also dries the mouth out, and when rubbed on the gums can erode the enamel. Both heroin and cannabis cause sugar cravings. Methamphetamine, or speed, is very acidic and cause rapid tooth decay. This has even led dentists to coin a term: 'meth mouth'.
Fluoride is the only supplement that has been shown to improve dental health. "Once your teeth have grown and they are outside the gums, doing things like taking calcium supplements or drinking lots of milk are pretty redundant," Clarke says. "If you have a proper calcium deficiency, it will be obvious long before your teeth are affected."
Fluoride is a form of fluorine. It is added to toothpastes and mouthwashes because it increases the resistance of enamel to decay. Water fluoridation in the UK started in the Sixties following successful trials showing an improvement in the oral health of children.
In 2003, a law was passed obliging all water companies to fluoridate their water if asked to by the Strategic Health Authority. At the moment, not all areas of the UK receive fluoridated water. Maps of the concentration of fluoride can be obtained from the Department for Environment, Food and Rural Affairs. Adding fluoride to public water supplies has been controversial, as there were arguments that over-exposure to fluoride causes bone cancer.
Fluoride is available in tablet form, but even if there is little or no fluoride in your local water supply, as long as you are using a fluoride toothpaste there shouldn't be a need to take a supplementary tablet unless advised.