Building good habits for better dental health

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  Posted by: Dental Design      23rd June 2024

Daily interdental cleaning is recommended by the NHS,[i] as it helps manage the build-up of biofilm, and can reduce the likelihood of developing gingivitis and periodontitis.[ii]

However, in a recent UK survey, only 37 percent of those aged 55 and over claimed to floss their teeth daily, and just 18 percent of 18 to 24-year-olds.[iii] It seems the interdental cleaning habit isn’t sticking here in the UK.

Dentists know that the best chance of successful oral health in adulthood is given by building up positive dental care habits, including interdental cleaning, in childhood.[iv] Even if we were lucky enough to have had this instilled when we were growing up, the challenges around building certain healthy habits is something all of us can relate to.[v] Maintaining a robust dental care routine, including interdental cleaning, can be even harder for some patients with impaired executive function.

Executive function and oral health

Executive functions are the high-level cognitive processes that govern one’s approach to adapting behaviour beneficially to circumstances. They affect the ability to problem-solve, make decisions or meet goals.[vi] A person with impaired executive function will struggle to connect tasks in the short-term to their longer-term benefits, and so can be at a disadvantage when attempting to form favourable routines.[vii]

The causes of executive function disorder (EFD) are not always clear; however, studies show that neurological conditions like Attention Deficit Hyperactivity Disorder (ADHD), and Adverse Childhood Experiences (ACE),[viii] as well as mood disorders are factors. It’s no coincidence that patients with these conditions are more likely to suffer from poor dental health.[ix] [x] [xi]

ADHD is a complex condition, but those with the condition may particularly struggle with forming and maintaining habits, no matter how beneficial. Symptoms are characterised by lack of attention, hyperactivity and impulsiveness, and it is very difficult for patients with the condition to foresee outcomes in any given scenario, both positive and negative. According to some researchers, the ADHD brain is in a state of ‘reward deficiency,’ related partly to differences in dopamine function. As a result, people with ADHD can be focused on short-term sensation rather the benefits of delaying gratification.[xii]

Many studies have looked at the connection between ADHD and oral health. Adolescents with ADHD are particularly at risk, as they have a significantly higher incidence of dental caries and gingival bleeding than those without the condition.[xiii] To maintain gingival health, young patients with ADHD need more attention from dental professionals and those responsible for their diet and oral hygiene.[xiv]

Oral health suffers where there have been ACEs. Particular connection between poor oral health and childhood neglect and abuse has been noted by researchers. Where there has been neglect of basic care, children can develop a range of disorders, many of which affect executive and cognitive functioning.[xv] Survivors of ACEs may present with a spectrum of oral health problems including erratic dental hygiene patterns, tooth loss, dental pain, periodontal diseases and dental anxiety in adulthood.[xvi]

Executive dysfunction can accompany mood disorders as well as other psychiatric conditions.[xvii] Individuals with mental illnesses are more likely to suffer from poor dental health; many common depressive symptoms, such as anhedonia or a lack of motivation, feelings of worthlessness, and fatigue, may adversely affect an adult’s ability to maintain regular habits around oral hygiene.[xviii]

Building good habits

 It’s never too late to work on improving executive function, even in patients with EFD.[xix] In cases of extreme impairments, medication might be considered, with cognitive behavioural therapy recommended to teach behavioural strategies and emotional regulation techniques.[xx]

Psychologists advise a gradual approach to building healthier patterns of behaviour, starting with small and simple changes, building new habits into existing routines,[xxi] and incorporating rewards, making them immediate and pleasurable.[xxii]

Anyone who has used a Water Flosser can attest to the simplicity – as well as the fun-factor – of incorporating it into a daily routine. The Waterpik® Water Flosser, accredited by the Oral Health Foundation, is also effective in removing up to 99% of plaque from dental areas, and is up to 50% more effective in improving gum health than string floss. The Waterpik® Cordless Advanced Water Flosser comes in an attractive range of lightweight, convenient and easy-to-use units. It is also rapidly rechargeable, ultra-quiet, powerful, portable, and easy to use, making it an easy addition to patients’ daily routines. It even be used it in the shower.

Clinicians may struggle to help patients incorporate regular, interdental cleaning into their daily oral care routines. Anything that helps improve dental health by making good habits easier and more appealing is to be embraced.

For more information on Waterpik® Water Flosser products visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Costco UK, Argos, Boots, Superdrug and Tesco online and in stores across the UK and Ireland.

Join the 3,000+ dental teams who have already benefitted from a professional Waterpik® Lunch & Learn. Book your free session for 1 hour of verifiable CPD and a free Waterpik® Water Flosser – available either face to face or as a webinar – at www.waterpik.co.uk/professional/lunch-learn/.

Susan Bio:

Susan joined Waterpik as a Professional Educator over 4 years ago. She is passionate about the work she carries out for the company delivering Lunch & Learn educational sessions to dental professionals. 

Susan graduated from Eastman Dental Institute School of Dental Hygiene in 1988 and now has over 30 years clinical experience working in Harley Street, specialist and orthodontic practices. Susan has a particular interest in treating periodontal patients and regularly encourages her patients to use the Waterpik water flosser to help maintain their periodontal health. 

Susan lives in Buckinghamshire with her husband and 9 year old son. She is a fitness fanatic and keen runner, having completed many marathons and half marathons.

[i] https://www.nhs.uk/common-health-questions/dental-health/why-should-i-use-dental-floss/

[ii] Iafolla T. Ask the Expert: Do I Really Need to Floss? NIDCR.nih.gov Available at:  https://www.nidcr.nih.gov/health-info/gum-disease/ask-the-expert April 2022. Accessed Feb 2024

[iii] Petruzzi D. On a typical day do you tend to floss your teeth. statista.com. Available at: https://www.statista.com/statistics/778872/teeth-flossing-likelihood-great-britain-by-age/ Feb 2022. Accessed Feb 2024

[iv] Duijster D, de Jong-Lenters M, Verrips E, van Loveren C. Establishing oral health promoting behaviours in children – parents’ views on barriers, facilitators and professional support: a qualitative study. BMC Oral Health. 2015 Dec 10;15:157. doi: 10.1186/s12903-015-0145-0. PMID: 26654364; PMCID: PMC4676163.

[v] Clear J. jamesclear.com. Simple Things You Can Do Right Now to Build Better Habits. Available at: https://jamesclear.com/good-habitsAccessed Feb 2024

[vi] Sam J. Gilbert and Paul W. Burgess, Executive function. Current Biology Vol 18 No 3 R110 2008 doi:10.1016/j.cub.2007.12.014

[vii] Executive Function psychologytoday.com. Available at:  https://www.psychologytoday.com/gb/basics/executive-function Accessed Feb 2024.

[viii] Aas M, Steen NE, Agartz I, Aminoff SR, Lorentzen S, Sundet K, Andreassen OA, Melle I. Is cognitive impairment following early life stress in severe mental disorders based on specific or general cognitive functioning? Psychiatry Res. 2012 Aug 15;198(3):495-500. doi: 10.1016/j.psychres.2011.12.045. Epub 2012 Apr 1. PMID: 22472845.

[ix] Begnini GJ, Brancher JA, Guimarães AT, de Araujo MR, Pizzatto E. Oral Health of Children and Adolescents with Attention Deficit Hyperactivity Disorder. Int J Clin Pediatr Dent. 2019 Nov-Dec;12(6):543-547. doi: 10.5005/jp-journals-10005-1691. PMID: 32440072; PMCID: PMC7229396.

[x] Akinkugbe A.A., Hood K.B., and T.H. Brickhouse Sage Journals. Exposure to Adverse Childhood Experiences and Oral Health Measures in Adulthood: Findings from the 2010 Behavioral Risk Factor Surveillance System. Volume 4, Issue 2.

[xi] Tiwari T, Kelly A, Randall CL, Tranby E, Franstve-Hawley J. Association Between Mental Health and Oral Health Status and Care Utilization. Front Oral Health. 2022 Feb 7;2:732882. doi: 10.3389/froh.2021.732882. PMID: 35199101; PMCID: PMC8859414.

[xii] Blum K, Chen AL, Braverman ER, Comings DE, Chen TJ, Arcuri V, Blum SH, Downs BW, Waite RL, Notaro A, Lubar J, Williams L, Prihoda TJ, Palomo T, Oscar-Berman M. Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatr Dis Treat. 2008 Oct;4(5):893-918. doi: 10.2147/ndt.s2627. PMID: 19183781; PMCID: PMC2626918.

[xiii] M. Blomqvist, S. Ahadi, E. Fernell, U. Ek, G. Dahllöf Dental caries in adolescents with attention deficit hyperactivity disorder: a population-based follow-up study Available at: https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0722.2011.00844.x August 2011. Accessed Feb 2024

[xiv] Begnini GJ, Brancher JA, Guimarães AT, de Araujo MR, Pizzatto E. Oral Health of Children and Adolescents with Attention Deficit Hyperactivity Disorder. Int J Clin Pediatr Dent. 2019 Nov-Dec;12(6):543-547. doi: 10.5005/jp-journals-10005-1691. PMID: 32440072; PMCID: PMC7229396.

[xv] Nikulina V, Widom CS. Child maltreatment and executive functioning in middle adulthood: a prospective examination. Neuropsychology. 2013 Jul;27(4):417-427. doi: 10.1037/a0032811. PMID: 23876115; PMCID: PMC3855039.

[xvi] Sartori, L.R.M., Pereira, D.H., Baker, S.R. et al. Association Between Adverse Childhood Experiences and Oral Health in Adulthood: A Systematic Scoping Review. J Fam Viol 38, 1607–1624 (2023). https://doi.org/10.1007/s10896-022-00470-x

[xvii] Rabinovici GD, Stephens ML, Possin KL. Executive dysfunction. Continuum (Minneap Minn). 2015 Jun;21(3 Behavioral Neurology and Neuropsychiatry):646-59. doi: 10.1212/01.CON.0000466658.05156.54. PMID: 26039846; PMCID: PMC4455841.

[xviii] Tiwari T, Kelly A, Randall CL, Tranby E, Franstve-Hawley J. Association Between Mental Health and Oral Health Status and Care Utilization. Front Oral Health. 2022 Feb 7;2:732882. doi: 10.3389/froh.2021.732882. PMID: 35199101; PMCID: PMC8859414.

[xix] Executive Function psychologytoday.com. Available at:  https://www.psychologytoday.com/gb/basics/executive-function Accessed Feb 2024.

[xx] Adult ADHD and Work: Improving Executive Function. psychologytoday.com. Available at:   https://www.psychologytoday.com/gb/blog/the-best-strategies-for-managing-adult-adhd/201601/adult-adhd-and-work-improving-executive Accessed Feb 2024

[xxi] Blain T. Benefits of Habit Stacking for ADHD. verywellmind.com Available at: https://www.verywellmind.com/habit-stacking-definition-steps-benefits-for-adhd-6751145  Oct 2022. Accessed Feb 2024

[xxii] Judah, G., Gardner, B., Kenward, M.G. et al. Exploratory study of the impact of perceived reward on habit formation. BMC Psychol 6, 62 (2018). https://doi.org/10.1186/s40359-018-0270-z

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