Oral Health: Healthy Canadians podcast episode 7



Megan Beahen: Hi, and welcome to Healthy Canadians: your space for nuanced conversations and expert insights about the help topics that matter to us all. We have practical information and resources to help you and your family stay healthy. I'm your host, Megan Beahen.

It seems obvious to say that our mouths are part of our bodies. But for a lot of us, oral health can seem a bit separate from our overall health. The "tooth" is… it has pretty major impacts on our general health throughout our lives.

We'll bite into all of that in a moment, but first: a word from us. Healthy Canadians is brought to you by Health Canada and the Public Health Agency of Canada. We aim to give you information and perspectives about the health topics that matter to all of us living in Canada. What we discuss won't always reflect the official positions or policies of the Government of Canada, but that's OK. These are conversations, not news releases. Okay! We've got a lot to chew on today. Let's talk about oral health.

Today I sat down with Lisette Dufour, Senior Oral Health Advisor with Health Canada's Dental Care Taskforce, and a dental hygienist with more than 40 years of experience.

Welcome Lisette, thank you for joining me today!

Lisette Dufour: Thank you very much, I'm very happy to be here.

Megan: I'm going to start off by saying I'm afraid to go to the dentist. I'm not afraid… I'm nervous about going to the dentist. I feel like this show could help people like me, maybe people have never even been to the dentist, or people who need to brush up on their oral health routine. Sometimes when I go to the dentist, I kind of black out. I'm not taking it all the information that I know I need to, and I know oral health is super important. So, tell me why you're so excited about talking about oral health.

Lisette: Well, I think it's important for people to understand the impact of oral health over their overall health. The more you know about a subject the less anxious you should be.

Megan: Love that! So, thinking about the "why" behind it, the "why" right? The why behind "we do these things for routine" makes it more meaningful and maybe more likely that we'll do them?

Lisette: Absolutely, because if you know why there's a reason that you should brush and you should floss, you're probably going to be doing it more often, right?

Megan: Absolutely! I also like the angle that we're talking about preventative measures rather than interventions. That's what we're going to talk about a lot today. How can we take care of our oral health really well, so we don't need some of those bigger, scarier interventions?

Lisette: Well, everything starts with prevention, right? If you go to the dentist on a regular basis, if you learn right off the bat how to take care of your teeth, you're not going to have to go through these –what people fear. You know, the local anesthetic (which is the needle), getting your teeth pulled, all of that. So, if you do everything you're supposed to do, then you probably may not have to go through all of these interventions.

Megan: Lisette, I just got a little sweaty.

Lisette: I know, I saw that! [laughs]

Megan: Teeth pulled… I mean, that is at another level.

Lisette: It is! It is!

Megan: I was thinking root canal in the back of my mind… but we won't go there. This is going to be a positive, fun conversation. [Laughs]

Megan: Okay, let's start at the beginning. We're going to talk about oral health throughout our lives. Let's start at the very beginning: when should someone start thinking about certain habits for maintaining good oral health?

Lisette: Well, if we have the opportunity to plan our pregnancy, I believe it starts right at preconception. To me, it's important to plan and make sure that you get your teeth cleaned up. To make sure that everything is fine, that you get an assessment done to make sure that there's not going to be a problem during your pregnancy. I'm not saying that you can't get the work done during the first trimester, it's just that as your pregnancy advances it's going to get less and less comfortable to be sitting in a dental chair for a prolonged period of time.

Megan: That makes sense. When someone is pregnant, are there specific things someone needs to do to take care of their teeth that's different than what you would normally do as an adult?

Lisette: Well because you're pregnant, sometimes our hormones are totally out of balance. Which can cause what we call "gingivitis" – so early stage of gum disease. Your gums may get puffy, they may get red, and they may bleed as well. Keep on brushing, keep on flossing, even if it bleeds. It's going to get better. However, make sure that everything is fine – go and see, check with an oral professional to make sure that everything is fine. If you need to get dental work done while you're pregnant, by all means it can be done, it's just that you may want to avoid X-rays, for instance, because you want to protect your baby and you want to protect yourself. Make sure when X-rays are unavoidable (and they could be unavoidable), make sure that you wear the lead apron to protect yourself from the radiation.

Megan: Okay, that makes sense. Keeping up with your regular, basic routine and going to see an oral health professional when you need to, when it's necessary. Okay, let's talk about babies. When does a baby need to start brushing its teeth? [Laughs]

Lisette: Well, usually babies are born without any teeth right? However, I've seen babies that are born with one or two teeth. It hasn't happened too often, but I've seen it happen before! So, after the feeding of your baby, make sure that you use a soft cloth to just dab or wipe the gums off, to make sure that you wipe off what's left of your feeding. It's important to do that, but it's also important for the baby to feel that it's normal, to get into that habit right off the bat until the teeth erupt. When the teeth are erupting, then it's time to use a soft bristled baby toothbrush.

Megan: Okay, so it starts before there's even teeth there!

Lisette: Yes!

Megan: Okay, when does a baby go to their first dental or oral health professional appointment?

Lisette: In Canada, we recommend to bring your baby to the oral health professional within the first six months of the first tooth erupting, or within the first year.

Megan: When can a baby start brushing its teeth – or maybe more of a toddler. Is it like, as soon as you can hold on to a toothbrush, you're good to go? [Laughs]

Lisette: Not quite. I think they need supervision for a while; at least until they can write their name themselves. They need to be supervised. Of course they want to gain independence, but…

Megan: Wow! That's a long time!

Lisette: Yes it is! So what we do suggest is usually to have them brush their teeth, but afterwards some supervision is required to make sure that they have reached all the areas that they're supposed to reach. It's very tough for them. So that's why it's important to ensure that you supervise your baby, at least until they are six or seven years old.

Megan: That makes sense. This might be controversial, but do you really need to take care of a baby's teeth? They're going to fall out anyway.

Lisette: Oh my God, I hear that one so often! "Why should I take care of baby teeth? There's a second set coming anyways?"

Lisette: You know, I think it's important because your first set of teeth is actually what is going to help the baby start to learn to speak, to eat, to masticate their food. Of course, the baby's teeth are going to fall off on a regular pattern, but that's normal. As soon as baby teeth start erupting and start falling, it's normal because there's another tooth underneath that's going to start to take its room. You actually need that space as long as possible. You need to keep those spaces to make sure there's space for the permanent teeth to come in. It's very important to keep the baby teeth.

Megan: That makes sense. So, thinking about a positive experience when you go... a parent is bringing their child to a dentist or an oral health professional, either for the first time, or maybe they're a little nervous. Are there things you can do to help make that more pleasant more positive?

Lisette: Makes me laugh, that question, because most of the time the parents are actually going to tell their child, "don't worry, it's not going to hurt!" Well, the whole time, while they will be sitting in the chair with the oral health professional, they'll wait for the time to hurt! So that may not be the appropriate thing to tell your child.

Megan: Okay, counter intuitive!

Lisette: So no need to say too much. "We're going to see the oral health professional. That person is going to look at your mouth, is going to maybe brush your teeth if there's a bit of plaque left…" That's about it. We want to try to make it as pleasant as possible as a first visit – and subsequent visits too! [Laughs]

Megan: Ok but being very honest with the child to say: "This is exactly what's going to happen, here are the steps" so they kind of know what to expect?

Lisette: Do not lie to patients who are sitting in the chair! Because it's worse. [Laughs]

Megan: [Laughs]

Lisette: Be as honest as possible, and make sure you use the appropriate language that the child will understand as well.

Megan: Okay, that makes sense. What about, you know, a prize or bribery? Do we recommend that at all?

Lisette: [Laughs]

Megan: I'll tell you, as a child, I loved going to the dentist because I always got a little something afterwards. What do you think about that?

Lisette: Well, this is more of a psychological way of doing it! I don't believe in bribes at all. I don't, I don't.

Megan: Okay, a hot topic!

Lisette: The hottest prize they can get after their visit is probably a toothbrush. So to me, is that a bribe? I doubt it. It's something useful.

Megan: That is spoken like a true dental hygienist. [Laughs] The biggest prize you can get is a toothbrush and some... some clean teeth, how about that?

Lisette: That's basically it.

Megan: Let's think about getting older. So, you're a teenager, young adult. Are there specific tips or things we need to think about at that age?

Lisette: Well, we've talked about little kids. We've talked about children. Now, as teenagers, it comes with school: the pressure, you know. What they are now drinking is specialty coffees, it's sports drinks… I don't want to say the brand name, but you know everybody has those. To me, I'm not telling you not to do it and not to have it, but you gotta make sure that you rinse your mouth with water afterwards. I'm not talking about, you know, athletes – elite athletes, they may need those sports drinks to ensure that they get all their electrolytes back. But us, if we are going to go outside, there's nothing better than a tall glass of water. There's no sugar in that. Let's make sure that we try to have a diet that has less sugar, and if you do have sugar, keep brushing or rinse your mouth.

Megan: Okay so, practically: If I'm going to school, I'm having a sugary drink during the middle of the day, I don't need to necessarily bring my toothbrush to school. I could go to the washroom and just rinse out my mouth.

Lisette: It would be nice, but I don't know a lot of teenagers who are carrying their toothbrush in their backpack, right? Let's be actually honest.

Megan: Realistic... right?

Lisette: Realistically, if they can have their bottle of water and they can swish with the water, that'll be good enough.

Megan: Okay, this might be controversial: what about if you use a straw? Is it better? That's what I heard; if you use a straw with a sugary drink it kind of bypasses the front of your teeth and it's not as damaging.

Lisette: Yeah, it could be better, but I hope you don't use a straw when you're gonna drink your rinse of... your drink of water...because it's gonna bypass.

Megan: You still have to rinse with water after!

Lisette: Exactly, exactly.

Megan: That's super helpful. Okay, so let's think about getting older. Adults and then seniors: what do they need to think about? And I'll just say, that I had perfect tooth health until I was about 30, and then it all went downhill. Is that a normal experience for people?

Lisette: Well, I tend to say as young adults, as children you're covered under your parents' dental benefits, right? But as you get older, and you come off the dental benefits from your parents, you may have a job that does not necessarily have the benefits. It's important to make sure, even more important that you brush and floss very well if you cannot afford the cost of tooth health, right? Of visiting an office as well. So, to me, what I've seen is young adults tend not to go to the dental office for a while until they get the benefits. And that's where usually... and if they don't take care of their teeth, and if they drink those specialty coffees all the time without rinsing, and if they don't brush adequately… at that time you will usually develop tooth decay.

Megan: Okay. So, a really important time, especially if you don't have access, to be doing all the good things to maintain good oral health.

Megan: Let's talk about an older audience.

Lisette: Well, more and more... in Canada, more and more, we are aging. We may not be aging healthy, but we're aging with our teeth now. Because people are... they know about oral health, and they know about tooth health, so they are keeping their teeth for a longer period of time than we used to. Because people may lose manual dexterity as they get older, it may be tougher for them to brush adequately. Because people are taking a lot of medication [as they age], it causes less saliva, so you may end up having more tooth decay because of that. Some cognitive impairment also may appear, so people may forget to brush or maybe forget how to brush. It is actually more and more important as you get older to ensure that you can brush – if you can't do it yourself, let's hope you have people or caregivers that can help you with that.

Megan: I was just going to say that; there's obviously a role for caregivers here too, right? To get educated – what is available, and tools to probably assist your older family members or friends.

Lisette: Exactly, we can find a lot online as well with regards to that.

Lisette: Unfortunately, this is part of reality, right? As we get older, we may end up having those issues. Let's hope we have the right caregiver and that they know what to do.

Megan: Absolutely. Okay, I want to jump into good oral health practices. Let's go back to basics. What are the essential things we need to do? Let's start with brushing and flossing: How often do we really – be honest – do we really need to brush and floss?

Lisette: Have you ever seen me not honest? [Laughs]

Megan: [laughs]

Lisette: I will say it right off the bat!

Megan: Give it to me straight, Lisette.

Lisette: You will visit a lot of sites, actually, that tell you to brush three times a day and I personally don't think you have the ability to be able to brush all the time. I believe in the equation "2 times 2", brush twice a day for two minutes each time, or the duration of a song. This is usually easy.

Megan: Love that.

Lisette: Each tooth has got five surfaces. Three that can be cleaned with actually a toothbrush, and two that must be cleaned with something that goes in between teeth like dental floss, right?

Make sure that you use a toothbrush that has soft bristles, because people tend to brush hard. Imagine if you use a hard-bristle toothbrush and you even brush hard, you may end up causing more damage to the enamel than actually doing some good. Use the soft-bristle toothbrush and use dental floss. There's a way of using the dental floss, and I feel that it's pretty tough sometimes to actually wrap the floss around your middle finger and use the four other fingers to hold it.

Megan: Yes, that's what I'm saying!

Lisette: Yah, no, it's tough! So they do have other products that can actually help out. It's called those "flossing aids". They look like forks.

Megan: Do you have one here? Maybe you could show those who are watching?

Lisette: I think I do. [Finds flossing aid]. And this is what it would look like. [Shows flossing aid]. So, it's like a fork and it's got a dental floss in between the two prongs of the fork, and you just insert it in between the two teeth, and you just floss as if it's a flossing mechanism. Go back and forth, and just go back into a seesaw movement and bring it down. These are great! They're actually cheaper, and it's easy to access. You can find them everywhere. If you don't want to use the fork you can use those toothpicks, but they're made out of... "du caoutchouc"... rubber! You just insert it and then you massage the gums. So it's really good, it gets rid of the plaque.

Megan: It's kind of like a toothpick with a little bit of rubber on the end.

Lisette: Exactly! These are fantastic.

Megan: Could you use that instead of floss, or in addition to floss?

Lisette: Try flossing the exact way I'm supposed to show you, but if you are not successful then you should be using those flossing aids.

Megan: Can you use that little rubber thing to clean around your retainer and stuff?

Lisette: Yep! You can! Yes, you can.

Megan: We could do a whole episode on why we still have these retainers… like, why?

Lisette: Those who have those retainers are those who had braces in the past, right?

Megan: Right, but like...do I still need that? It's been 25 years.

Lisette: I think it's individually based. So you will need to talk to your own oral health professional.

Megan: Okay, maybe we can do a quick assessment after the camera stops rolling...

Lisette: Yeah, sure – off camera! [Laughs]

Megan: [Laughs] Exactly. Ok, flossing. How often?

Lisette: Flossing is...you have something for dinner, and you feel something is caught? Well, use your floss, right?

Megan: I'm with you on that!

Lisette: But the flossing is the same: twice every day. But the most important time...

Megan: Twice every day? Flossing twice every day?

Lisette: Yeah! Keep into the habit of brushing and flossing at the same time. Once you're done with one, do the other one. But if you can't brush or floss twice a day, the bedtime time is the most important time. Because you want to get rid of as much plaque as possible before you go to bed, and not give a chance to those bacteria that are surrounding your teeth from staying in there all night. Right?

Megan: Ok, that's good to know.

Lisette: It's logical; it's easy to remember.

Megan: Absolutely. I mean, I feel like I'm really airing my oral health habits now but... [laughs] I'm a great tooth brusher – no problem there. It's the flossing that is a hurdle for me, and I feel like other people share that experience. Getting a good habit… probably just timing it with your tooth brushing? Is that the best tip to make it become a habit?

Lisette: To me it is. And people that have tight, tight contacts between their teeth...

Megan: That's me!

Lisette: I know, I saw it.

Megan: See, you already knew!

Lisette: I've got a trained eye.

Megan: Thank you! It's harder for people like me. Because sometimes it snaps in there, and you've got to really wiggle it in.

Lisette: You may want to use the waxed floss. It's more slippery, so it slides in through much more easily. Or, you may want to use what we call a water irrigator.

Megan: I was just going to ask you about that!

Lisette: It's costly, so this is something that I probably would not advise to everyone. However, if you can afford it, and you have tight [tooth] contacts and cannot use the traditional dental floss, maybe a water irrigator might work better for you.

Megan: Okay, so not essential but I could invest in one if I wanted to, kind of thing.

Lisette: Yes. Yes!

Megan: And should I be flossing in front of the mirror? Or can I do it while I'm watching TV?

Lisette: So when you floss, usually... some dental hygienists have this bad habit of showing how to floss in front of a mirror. Everything you see in a mirror is opposite of what you actually see. When I look at the mirror, my right hand is my left hand, so it's the left side… to me, it's so much easier to not limit yourself to the bathroom, in the mirror. You could actually do it whenever it's a good time for you. No need for a mirror. Just go by feel, how you feel it. You'll feel it when it's clean and when it's...you will feel it.

Megan: I like that! Because I don't want to stand in the bathroom that long.

Lisette: Non, non.

Megan: Okay – toothbrushes. Do you need a fancy toothbrush? Do you need an electric toothbrush?

Lisette: No. Again, if you can afford those nice toothbrushes that are vibrating, or they're round… these are all great toothbrushes. It's just that if you can adequately brush properly, get rid of your plaque with the traditional toothbrush with soft bristles, why spend more on something that works?

Megan: Yeah, I mean… I buy the one that's on sale. But as long as you buy the one that's on sale and it has soft bristles, you're good?

Lisette: Exactly. Yup, yup.

Megan: Okay. What about fluoride? I feel like I used to get fluoride at the dentist, and now I don't. Is it good for you? Is it essential? What's the deal?

Lisette: Fluoride is important. It's a natural element that you can find in the air, in the soil, so you don't need to worry about fluoride. It's actually found in toothpaste, so it's not how much you use, but the frequency that you're using. So if you do look, Health Canada recommends to use just a tiny grain of salt for our little ones, our little children, toddlers. Ages zero to three, ll you need is a grain of rice. As you age, from three to six, a small green pea-size is more than enough. I used to see those TV ads where they used a whole swirl! How beautiful it looks – but that's way too much – there's no need! A tube of toothpaste should last you for quite a while.

Megan: Should I be looking for toothpaste that has fluoride in it?

Lisette: Yes!

Megan: Yes! What about a whitening toothpaste? Is that getting too specific?

Lisette: Yeah, it's getting too specific.

Megan: Okay, that's fair.

Lisette: Then we'd have to go into more scientific.

Megan: There's all different kinds.

Lisette: You'd actually need to visit an oral health professional...

Megan: To get your specific recommendations, right?

Lisette: Yeah, because they need to see how thick your enamel would be as well. So it's important...

Megan: Ok, so we can talk after and you can tell me what kind to get. [Laughs]

Lisette: "C'est ca!"

Megan: Okay, let's come back to accessibility. Let's talk about accessibility, because not everyone, probably, who's listening sees an oral health professional. Or, maybe they're not seeing one consistently. Could you talk about the importance of that?

Lisette: Well, we know in Canada that about 75% of the population have reported [visiting] an oral health professional in the last 12 months. But, we know unfortunately that is 25% that haven't. We also know that about two thirds of our population has access to dental insurance. So, we know then that there's about 33% that don't have access to dental insurance. But in the meantime, there's a temporary Canada Dental Benefit for children under 12. This has actually, currently helped hundreds of thousands of children under 12 to access dental care, so it's helping right now. We're helping and improving access to oral health care.

Megan: Very cool. We're closing the gap. We're addressing the gap.

Lisette: Yup, yup. Exactly!

Megan: Very cool. We're almost at the end of time here Lisette.

Lisette: Already?

Megan: I know! You are a Senior Oral Health Advisor with Health Canada. You're also a dental hygienist. What is the best part of your job? I ask that because you seem very excited about oral health!

Megan: Well, I've got a few years left at the government. So, to me, having the opportunity to work on the public health programs that will look at the prevention – not just at the treatment portion – to me, that was the best possible way to end my career in the government as a dental hygienist. That's what's important to me. I'm passionate about the public health. I'm not passionate about all the gadgets that could happen. It's just: how can we effectively clean our teeth, and make sure that the oral health status is adequate for all the Canadian population? That's what's important to me.

Megan: Very cool!

Lisette: Thank you.

Megan: You've talked to lots of people – I can tell – about their oral health, what has been the best piece of advice? What do you think people need to know the most?

Lisette: Well, I think they truly need to understand the impact of oral health on the overall health. Because for years, for ages, you've had the overall health on one side, because you go see a doctor and you do all that. But it's funny, because the mouth doesn't seem to be in the body itself? So, to me, I think it's important that they get to understand the link between oral health and overall health.

Megan: Love it! We'll put some links in the show notes about resources. Is there any resource you want to throw to right now?

Lisette: I actually could address the audience to the Government of Canada. Then, just click in the key words "oral health": it'll bring you to a whole bunch of links, and to a whole bunch of information that's very adequate for people who want to know a lot more about oral health.

Megan: Okay, so canada.ca, just type in oral health?

Lisette: Exactly, then it'll take you to four or five oral health web pages. Some of them are how to take care of your teeth, and it's got the specific age groups. It also has a page on fluoride, and it has a page on the Canada Dental Benefit, as well. Currently that's my best offer to you.

Megan: That's great! Thank you so much, Lisette. It has been a pleasure talking to you… and let's chat more about my teeth after the show. [Laughs}

Lisette: We will, we will! It's my pleasure. Thank you so much for inviting me.


Megan: Thanks for tuning into Healthy Canadians. If you're watching on YouTube, don't forget to click the like button below, and subscribe to stay up to date on future episodes. Find us wherever you get your podcasts and leave us a review if you like what you heard. For more information on the health topics that matter to you, visit canada.ca/health.

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