I had a very interesting morning today. I was invited to speak about teeth at a homeless shelter in St James's Park at the Passage Day Centre. The topic was 'Talking Teeth with Dr Flora'.The Passage Day Centre provides a service to over 200 homeless men and women on a daily basis. Their mission is to provide resources which encourage, inspire and challenge homeless people to transform their lives. My job today was to talk about teeth and educate the residents on the importance of good oral hygiene. The group was very enthusiastic to find out more about what I had to say.

September is the National Colgate Oral health Month this month, and Colgate is promoting what they are calling their 'healthy mouth mission'. I thought this was very relevant to the small group who had gathered to listen to me speak, so we touched on the following topics:

1. Brush your teeth twice a day with a fluoride toothpaste, last thing at night and on one other occasion.

Based on our discussions, it was established that the group mainly brushed once a day. This tended to be in the morning. The nights they found themselves sleeping on the streets, they would not brush their teeth. They did not always brush with a Fluoride toothpaste – the type of toothpaste they used was dependant on the cost of the toothpaste – the cheapest brand being the most favourable.

2. Just spit after toothbrushing, rinsing washes all the fluoride away.

I am not sure how much agree with this, as not rinsing after brushing would mean having a taste of toothpaste in your mouth all day, so we agreed that a gentle rinse may be more favourable.

3. Avoid toothbrushing straight after acidic food and drinks to help prevent enamel erosion.

We had a debate about whether to brush before or after breakfast. I explained my reasons for encouraging brushing after breakfast (please see my previous post). We also discussed how it would be best to brush at least 30minutes after having had an acidic drink such as a fruit juice. We also used this opportunity to discuss diet and the importance of avoiding acidic drinks like pop such as coca cola – whether full fat or diet.

4. Keeping your gums healthy by cleaning between your teeth using floss or interdental brushes.

Our discussions showed that none of the group flossed their teeth – mainly due to the cost of buying extra dental gadgets, but also lack of ease of flossing. I demonstrated the use of interdental brushes and flosspicks to the group, which they all agreed made the job a lot easier. I left them with plenty of samples to ensure they will hopefully be flossing for a long time after I left.

I thoroughly enjoyed my session at the shelter. I learnt a lot, and the group were very complimentary about the information I gave. The feedback I got was very interesting, but one of the main conclusions I deduced was that they were not happy with the NHS service they were being provided. One gentleman expressed his discontent at having had to wait for 2 years to have a set of denture made – this procedure would normally take an average of 4 weeks. Another lady had been back to visit the dentist 5 times to have the same tooth treated, and this was still causing her a lot of pain on chewing. They felt they were being treated 'less favourably' because they were homeless and felt that maybe if they were not homeless they would have received a better standard of dental care. I explained that I did not feel this was the case, as even people who pay for NHS treatment may still be subject to similar treatment. After spending 30 minutes trying to convince the group they were not being victimised due to their circumstances, I realised I needed to do something other than talk and talk and talk. These people were in need of dental treatment, and I am a dentist. So why can't I help them? As a result, I agreed we would meet at the Covent Garden Dental Spa on a date in October and I will provide my new friends with the dental care they have been missing and deserve, compliments of the Covent Garden Dental Spa. This is my contribution to putting a smile on the homeless faces of London. 

I woke this morning, and for the first time in a long time, my bedroom was dark at 6:30! OK, I get it now, summer is officially over. Actually, hold on, what summer? You can't call that a summer. So I will rephrase, Autumn is here – Autumn's predecessor – whatever you want to call it – is officially over! So, there are a lot of changes, the days are shorter, the temperature has dropped, scattering of showers, leaves are falling, the tubes are more packed, the phone at the Dental Spa is ringing a lot more. Yes, Summer (I concede) is over!

So my task today was to compile an 'end of Summer to do list'. Somewhere near the top of my to do list which is as long as my arm, is task 17. Update blog page. I log onto my blog page – last entry – June 13 2011. I calculate, hang on, I have been AWOL from my own blog page for more than three months. So what is my excuse? I was too busy having a fun summer! As much as I complained and moaned about the summer, or lack there of, reflection shows and proves that I was having a fun time! All the barbeques, music festivals, summer city breaks, weddings, picnics, long summer evenings dining al fresco! So now, it is time to buckle down, kids are back at school, and so am I – back to the drawing board.

So I will start off my Autumnal blogs with a debate – do you brush your teeth before or after you have had your breakfast? When I ask my patients, it is amazing how the responses I get are 50/50.

Here are my thoughts and what I routinely advise:

I always advise it is best to brush our teeth after breakfast. This is important, as after you have had your breakfast, certain foods and bacteria will settle on your teeth.
Imagine this – You have just brushed your teeth, then you eat your cereal. The bits of food from your cereal will settle on your teeth for the whole day until you next brush, which, for most, is in the evening before they go to bed. The combination of the plaque and bacteria will release acids which can then cause tooth decay, and the accumulation of bacteria on your gums over long periods of time may contribute to the development of gum disease.
Brushing soon after breakfast will ensure there is less plaque and bacteria on your teeth throughout the day.
If you have a fruit juice or eat plenty of fruits for breakfast, I advise to brush no less than after 30 minutes after. Fruits and fruit juices are acidic and weaken the enamel. Brushing soon after consuming these could potentially harm your enamel.

I also advise gentle brushing after lunch to help reduce the chances of this build of plaque and bacteria. If you are a frequent tooth brusher, please do make sure to use a soft bristled toothbrush or an electric toothbrush as overzealous brushing can lead to abrasion to the teeth or recession of the gums. For this reason, I advise my patient to brush no more than three times per day.