Ellen Guritzky and Anousheh Alavi from Haleon, with CHPA's Anita Brikman, discuss the importance of preserving gum health to avoid tooth loss. They explain how plaque buildup can lead to more serious conditions and stress the importance of compliance and commitment to oral care as part of self-care at home. Catch the full conversation on this episode of CHPA Chat.
- Episode Transcript
Anita Brikman: Just ahead on this episode of CHPA Chat, a discussion on gum health in America, and how one CHPA company is working with clinicians to provide better oral health with humanity.
Speaker 2: Welcome to CHPA Chat, conversations in the consumer healthcare industry with Anita Brikman.
Anita Brikman: Welcome everyone. Today I am joined by a dental hygienist and periodontist by training who are both medical affairs professionals at Haleon, formerly GlaxoSmithKline Consumer Healthcare. Ellen Guritzky and Anousheh Alavi are passionate about helping people preserve their gum health before it's too late and tooth loss becomes inevitable. According to the American College of Prosthodontists, more than 36 million Americans do not have any teeth, and 120 million people in the US are missing at least one tooth. Ellen, those are startling statistics.
Ellen Guritzky: Anita, you're absolutely right. And first, I want to thank you very much for having us and raising the awareness of such important conditions. These are staggering statistics, but I want to build on these statistics because according to the Center for Disease Control, the CDC, over 47% of adults in the US, ages 30 and above, have some form of periodontal disease. There are about 30% of adults that have moderate gum disease and 8.5% with severe gum disease. Early gum disease, which is known as gingivitis, is a mild form of periodontal disease. And the best part is it's reversible. People have early gum disease and their problems will notice that there's some blood in their sink after brushing. Their gums may be red or inflamed, and the problem is there's no discomfort at this stage and they don't seek professional help quickly enough. And the other part is their compliance with oral care at home is not great, but they need to know that this is reversible. So, if they did get that treatment, it would be much easier for them.
It's also important to know that plaque, which is a sticky colorless film, is constantly forming on your teeth. The bacteria live in the plaque and they produce acids that could cause tooth decay and irritate the gums. Why is this so critical? Well, it's important that they take care of their teeth and remove this and disrupt it constantly because the more it's disrupted, the less it will build up, the less it will form. But if it does, it forms into something that everybody's pretty familiar with, which is tartar or as professionals call it calculus, which is very hard and it needs to be removed professionally. All right? Haleon has specialty toothpaste known as Parodontax that can help address these problems, and it's important to mention that compliance and commitment is the key to success. That means brushing twice a day for two minutes and following up on the home care regimen given by your dental professional.
Anita Brikman: Anousheh, let's follow up on what Ellen just said. I mean, this seems like there is a long window when there is a chance to reverse this pathway toward more serious disease. When does this typically start for people?
Anousheh Alavi: That's a really interesting point because obviously how the gums are responding to bacteria that sits right next to them on the teeth, this is actually a protective mechanism. Actually, our immune system is very efficient at stopping bacteria that are accumulating, as Ellen said, all the time, gaining access to the inside of our body and actually causing problems. So, the inflammatory response is keeping the bacteria out, but as a consequence, and because it's forever forming, that's where the damage starts. Not everybody who gets bleeding gums or gingivitis will progress to have loss of the tissues that are supporting the teeth and holding them in place, but certainly roughly around 30%. It varies by countries of those that do have gingivitis, which as Ellen said is reversible, will actually have it go to the point where there's less and less support around teeth and the structures that hold them in place.
And remember, because gums are painless, the amazing job that they do in health is sometimes underestimated. This is the most elaborate suspensory mechanism in the body that every tooth is behaving like piano keys and actually adjusting to our bite to what we're biting. It could even be a different aspects that are being chewed and enjoyed in our daily food. So, there's a lot about how much we need to obviously eat to survive, but also the joy of food is dependent on the whole system working efficiently. The challenge is a lot of bleeding when it's noticed, because it's symptomless, everybody automatically assumes, "Ah, I must have cut it or I must have been quite rough." And the natural tendency is then to go easy on the areas and clean them quite gingerly. And actually quite the opposite is true.
And that's almost why the advice the dentists and dental hygienists give is almost counterintuitive. If you'd cut yourself and somebody said, "Oh, you have to scrub it really hard." That doesn't sound quite right, but in the sake of the gums, it's about giving them a helping hand. Now, you asked when does all this start? Obviously as adults get older and older, not because it's an aging process, but the cumulative effect is more noticeable from the middle-aged onwards. So, there seems to be, although that's not the pattern, as if with age we also get longer in the teeth and we're not going to have enough teeth or supporting structures around them. Strictly speaking, that's more wear and tear. And actually in adult patients, obviously as well as we see in consumers and their need to look after their gums, the older people get, the more important and critical it is not only to reverse gingivitis, but also to stop periodontitis and not let it go any further. It's never too late.
Anita Brikman: Anousheh, I'm going to follow up with something here 'cause you are a periodontist. You said, okay, so let's say it has progressed to that point, is surgery sometimes necessary to try to stop that progression?
Anousheh Alavi: Yes, there will be all sorts of professional interventions including surgery, which will be beneficial. But the most important thing with regards to anything to do with gum health including complex surgery is unless on a daily basis, patients, consumers can actually find a way with their dental professional to make it work so they keep the plaque below the critical point where it starts to damage their gums. It is actually the home care, and this is where consumer health and Haleon comes in, that is the most critical as well as the professional intervention, which includes surgery to make it work.
Anita Brikman: Ellen, let's follow up on that. We're talking about the surgery, but what Anousheh just said is what happens afterward, the follow-up visits, the home care can really make the difference between success and failure. Is that the case?
Ellen Guritzky: Absolutely, that is the key to success. Making sure that the behavioral habits change so that people are actually following what the dentists and hygienists have given them to do. I mean, the simple story is to brush twice a day for two minutes a day, visit their dentist and hygienist on regular treatments, adopt a very healthy diet, and use a soft bristle brush and a specialty toothpaste along with their flossing and their other regimen that's recommended by their professional.
Anita Brikman: What about insurance? Does it sometimes impede how often people return for that follow-up care?
Ellen Guritzky: Yeah, unfortunately, some people have the mantra of thinking, well, my insurance is going to dictate when I go to the office as opposed to when their health dictates when they go to the office. And so, typically, health insurance in the United States, dental insurance I should say, allow for two times per year. All right? But there's patients that need far more treatment, and I mean, when I was practicing as a clinician, I would have patients in once a month or every other month because they needed that attention in order to keep their mouths healthy. So, that does become a problem insurance-wise. And then, there's a great number of people in the United States that unfortunately do not have dental insurance, and that's a roadblock in and of itself because they can't afford it or they just don't prioritize it as easily or as fast as they should. And the problem with that is they only go to the office when there's a problem, and then were kind of having a tough way to go back to ground zero when they've already experienced so much discomfort or pain.
Anita Brikman: Anousheh, let's talk about the millions of people who do eventually end up needing dentures. Do you think most dental professionals have a true understanding of what their lives are like?
Anousheh Alavi: This is such a good question Anita, 'cause I've asked myself this. I have an academic role as well as obviously how I work with team and including Ellen in medical affairs at Haleon. I found prosthodontics quite complicated. The magic of the mouth is the fact that people who wear dentures actually managed to cope with them with the minimal amount of support from the time the dentures fitted, and you would not be able to cope like that with any other form of prosthesis. The challenge is, dental professionals are trained to provide the prosthesis, what they don't know is what it's like to live with them, which is basically that's what's happening to people who have dentures. Can we be better as clinicians? Absolutely. But is there a gap between what our patients experience from the time we let them leave the practice, and what our consumers come back and tell us in terms of their experiences, their life journey? I have to say I've learned more.
I chose periodontology 'cause that was all about repair and all about soft tissues, but actually in terms of honestly, human resilience, but also realizing how much of a stigma it is socially and how people struggle to even let their loved ones know that they've actually got a denture that needs to be taken out. It's probably the most amazing experience I've had in terms of trying to understand how it is not just the dental profession, but there's all of us. We need to do our bit to provide at least a little bit more support and certainly a hell of a lot more comfort for people with dentures and that it's not a shameful thing. It is social norming, it is understanding that as we age and we know the population all over the world, including most definitely the US we're all aging, that we are all going to retain more of our teeth than any previous generation.
And that losing teeth is not a condemnation or a sign that we have not looked after them. It's certainly even more critical that we look after our remaining teeth because any form of replacement is going to impact or at least put the remainder of the natural teeth at greater risk. Every sort of restoration, whether it's removable, whether it's complex crowns and bridges, they're all going to attract even more plaque and be even more complicated to keep plaque-free. So, both accentuate looking after the gums of remaining teeth, but also the daily experiences and the quality of life that people with dentures have to experience. And that's the most, I think, exciting area where Ellen and I have endless discussions about what else can we do and how can we share that back with our colleagues, our clinical colleagues, as to what the experience of consumers and patients is like outside the practice.
Anita Brikman: Anousheh just mentioned your clinical colleagues. Ellen, how do you interact with the dental profession based on the science of what you know, but also with the empathy that we need to have for people through all stages of life, regardless of what their dental situation is at that moment?
Ellen Guritzky: Yeah, it's very important that we interact with our clinicians, and we do that through partnering with various organizations like the American Dental Association, the American Dental Hygiene Association, partnering with and collaborating with them so that they can trickle down the information to the grassroot clinicians, or we also know them as the everyday clinicians. Those are the people that are actually treating patients in offices, in clinics, in schools, et cetera. We also pride ourselves in talking to the students because the students are our next generation.
Anita Brikman: Anousheh, what surprises you most when you tag team this with Ellen and you're doing this kind of education to the clinician? What are the knowledge gaps or the preconceived notions that surprise you most?
Anousheh Alavi: It's really interesting. I think the reality is clinicians don't know what they don't know, and some of the experiences that we share with them, they may not have had before or they may not have thought about it. So, let me give you an example. One of the areas that we work, and again, as Ellen said, we're bringing our understanding, consumer needs, as well as obviously the clinical and scientific led areas together is, for example, in medicine, I'm just trying to illustrate an example. In medicine, it's less about you either are diseased or you're healthy. There's all sorts of shades in between. And I think in dentistry for a long time, it's been a case of, "Oh, I need a filling." Or "No, I was fine. I went for my checkup and I didn't need anything."
Actually, it's all the bits in between that are even more impactful in terms of lifestyle and effect on oral health.
For example, we partner with medical sociologists and they look at experiences of patients/consumers in terms of what they've been given or what disease they have or what has the treatment meant to them. We work with behavior scientists with regards to how complex it is when the dentist tells patients what they expect them to do, and then they are usually disappointed when the patient comes back and it's not quite been like that. It's trying to help them understand it's not so easy to change behavior. It is really difficult for adults in particular, which is why children start so early in terms of looking after their teeth. But trying to add routines later on in life is so much more complex.
And just as an example of what I learned a lot, so obviously throughout our clinical training and then in practice, I've been providing removable dentures just like all of my colleagues have. And I had this amazing experience of, and we talked about this with actually our partners in a couple of dental academic institutions as to how this would be an eye-opener for dental students for us to sit down with the patients that we've provided dentures for and have a meal with them and have a conversation about what has been their experience and to actually change the dynamic. Now, is that possible for established clinicians? Maybe not. And is that so easy to organize in a clinical dental school setting?
Well, maybe not. But I can tell you how enthusiastic the dental students were and how they thought that would be absolutely amazing. We did a symposium at the World Federation of Dentistry about the secret life of dentures, about everything that goes on about dentures when patients leave their practice, become the family member, the loved one that they are within their family and become consumers. And it was absolutely incredible in terms of the amount of enthusiasm and just interest in how little this area has been explored. So, we have the privilege with Haleon because the objective is to improve, in our case, oral health with humanity.
I think the humanity piece comes in, yes, the trusted science, yes, the latest clinical evidence, but absolutely with the perspective of consumers and their expectations and their lives, which we as know they're actually far more sophisticated. We should never underestimate them in terms of their understanding and certainly their expectations. We have to match that, otherwise they'll be disappointed. And honestly, it's a privilege to do so.
Anita Brikman: I am so heartened by that. Ellen, any final thoughts on how we meet those consumer expectations as an industry and serve their needs in self-care?
Ellen Guritzky: As Anousheh said, we want their oral care to be top of mind as opposed to everything else. And when you look at it this way, the mouth is the gateway to everything in your body. So, it starts the second you smile as to how you can reach your population and make sure that you're healthy and you're loving life.
Anita Brikman: All right. That's leaving me smiling and loving life, and very much more informed about oral health through all stages of life. Ladies, thank you for joining me for a very insightful CHPA Chat.
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The views expressed in this podcast are solely those of the speaker and do not necessarily represent the opinions of the Consumer Healthcare Products Association.
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