Dental Health Week 2018: Watch Your Mouth

The Australian Dental Association’s theme was Watch Your Mouth: not just your teeth, not just your gums — your whole mouth.

You have heard the basics before: brush and floss regularly, eat less sugar, see your dentist more than once a decade. So here are the lesser-known facts about a part of the body that is routinely underprioritised. If you want the basics anyway, they are in what is the ideal daily routine for oral hygiene?, caring for your teeth: 8 steps to dental health and how often should I go to the dentist?. Dental Health Week 2017 and Dental Health Week: protect your kids from the Sugar Bandits are the other years’ campaigns.

Tongue cleaning

You brush your teeth and floss between them. The area most often overlooked is the tongue.

The tongue contains 70% of the mouth’s bacteria.

It accumulates a coating each time something is introduced into the mouth, and can even temporarily discolour as a result. The ADA describes the surface as covered in millions of tiny bumps called papillae, which give it its texture and "can collect bits of food and of course millions of bacteria or microorganisms, called flora" — adding, memorably, that "just like your thumb print, the tongue flora is different for every single person", and that the mouth typically hosts around 700 forms of bacteria.

What to do: every time you brush your teeth, gently brush the top surface of your tongue. Use a soft electric or manual toothbrush and do not apply much pressure. The ADA's own instruction is worth following exactly: "start gently at the back of the tongue, pulling or brushing forward and use water to lubricate the process so the brush doesn't drag along the tongue surface", and "you need to be very gentle because the tongue surface is delicate and sensitive". The 2014 international consensus on halitosis adds two limits: clean the top surface only, not the sides, and there is no case for tongue cleaning at all where there is no coating. Do I need to use a tongue scraper? and should I use a tongue scraper? answer the obvious follow-up question, and which toothbrushes do dentists recommend? the other one.

One honest caveat on what it achieves. Reducing the bacterial load on the tongue is not the same as fixing bad breath, and the ADA is unusually blunt about this: "a review of the scientific evidence in 2019 found no evidence that cleaning your tongue, using several different methods including mouthwash or chewing gum, were effective for managing the cause of halitosis." The Cochrane review behind that statement rated the evidence for mechanical tongue cleaning very low certainty. The ADA's own page description puts the defensible position in one line: cleaning your tongue reduces the bacterial load, "but the impact of this reduction has not been proven yet".

So: clean your tongue, gently, as part of the routine. Do not expect it to solve persistent bad breath on its own. Bad breath that survives a clean tongue and good hygiene usually has another cause — most often a dry mouth or gum disease — and the ADA notes it can also come from "other areas of the body including the lungs and the nose". Either way it is worth having looked at rather than masked. See bad breath, what causes bad breath and how can I fix it? and 7 ways to avoid bad breath.

Flossing around obstacles

Tooth-brushing only reaches 65% of the tooth surface. Which means not flossing neglects 35% of the surface of every tooth — and it is the part between the teeth, where decay and gum disease most often begin. Is flossing really that important? makes the full case, and how does tooth decay develop? explains what starts there.

Flossing is nobody’s favourite task, and fixed retainers or braces make it harder again — the ADA agrees that "cleaning between your teeth with string floss can be tricky while wearing braces", and points to floss threaders and interdental brushes instead. Some things that help:

  1. Flossettes or flossers — small slingshot-shaped instruments with a plastic handle, which make the action much easier
  2. Pikster interdental brushes — for wider gaps and hard-to-reach areas; they come in a range of sizes
  3. Superfloss — for cleaning around braces or fixed retainers. Each piece combines three types of string in one, so you can thread between obstacles and clean tight and wide areas at once
  4. Floss in front of the TV, a laptop, or a book propped on your knees — the barrier is usually boredom, not difficulty
  5. Make a habit of it, and it becomes as automatic as brushing

What brushing and flossing together cannot remove is hardened tartar — when do you need deeper cleaning? and dental cleans with our hygienists explain where the professional clean takes over, and should I be using mouthwash as well? why a rinse is not a substitute for either.

Dummies, pacifiers and thumb-sucking

In infants and young toddlers, dummies and thumb-sucking reflect the sucking reflex, and are an effective comforter.

Continued use can hinder the development of a child’s teeth and mouth. Because of the prolonged position of the dummy or thumb, long-term effects may include:

It is best to discontinue use before your child is two.

If you have concerns about your child’s habits, speak to your dentist or GP. See also baby teething, the order and appearance of baby teeth, when should a child first visit the dentist?, protecting your child from dental disease and children’s dentistry.

Tongue and lip piercings

Jewellery comes in and out of fashion; the risk to your mouth and teeth does not change.

Lip and tongue piercings regularly contact your teeth and gums and, through movement, can:

The long-term effect on gums can be severe. The gum tissue recedes — shrinks away from the tooth — exposing the root, which causes sensitivity, exposes it to bacteria, and leads to decay if untreated. Root surfaces have no enamel, so they decay faster than crowns do.

Gum recession does not reverse, which is what makes this more than cosmetic — periodontal (gum) disease and bleeding gums.

If you want to keep the jewellery, remove it during periods of increased risk: while eating, sleeping, brushing, or undertaking strenuous activity. Ask your dentist for an assessment — are tongue and lip piercings bad for teeth? goes into more detail.

Smoking and dental health

Most people know smoking carries serious risks including oral and lung cancers. Less known are the specific effects on the mouth.

On oral cancer specifically, tobacco and alcohol are among the best-established causal risk factors, and they compound rather than simply add — oral cancer: signs, risk factors and how your dentist can help and what are the causes, symptoms and treatment of mouth cancer?. The single most useful thing to know is what oral cancer does not do. Writing for the RACGP, the authors of a review of oral cancer in general practice note that early signs "are generally painless", with the commonest presentation being a persistent, non-healing ulcerated lesion, sometimes alongside loose teeth, bleeding, or pain or numbness in the mouth or face. Their threshold for action is explicit: anyone with unexplained or non-healing changes in the mouth for more than two to three weeks — a persistent ulcer, red patches, lumps, a sore throat — should have an oral cancer screen. Any ulcer, lump, or red or white patch that has not healed in two weeks should be examined, and waiting for it to start hurting is precisely the wrong test.

It starts at the lips. Frequent closing of the lips around a cigarette leads to permanent wrinkles around the mouth.

The smoke then stains the teeth and discolours the gums and tongue. How can I improve the whiteness of my teeth? and teeth whitening address the staining — though whitening treats colour, not the underlying causes.

Delayed healing

Tobacco and its thousands of toxins restrict blood flow to the mouth, by affecting the epithelial cells lining the blood vessels.

The consequence: ulcers, cuts and injuries take longer than normal to heal, because the healing cells struggle to reach them. Healing after any dental procedure involving the gums or soft tissue is delayed too — which is why smoking status changes surgical planning, for implants, wisdom teeth and periodontal surgery alike.

Tooth loss

Tobacco affects your immune system’s response to bacteria in the mouth, significantly increasing the risk of gum disease. It is a major risk factor for periodontitis in its own right, independent of everything else on this page, and Diabetes Australia asks patients to tell their dentist whether they are a current or previous smoker for exactly that reason.

Gum disease, left untreated, causes bone loss around the teeth, leaving them loose in their sockets. That is the mechanism by which smoking costs people teeth — and then what are the replacement options for missing teeth? becomes the conversation. Advanced cases are managed by a periodontist.

There is a trap here worth naming: nicotine constricts blood vessels, so smokers’ gums bleed less — and bleeding is the warning sign most people rely on. The disease is routinely further along than it looks.

And vaping

Most people who stop smoking now switch rather than quit outright. The vaping evidence base is much younger than the tobacco one, so the long-term picture is genuinely unsettled — which is not the same as safe. The shorter-term oral effects are reasonably clear: the effects of vaping on your oral health and are e-cigarettes bad for my teeth?. Quitline is 13 7848.

Looking after your taste buds

There are up to 5,000 taste buds in the adult mouth.

They work with your sense of smell, and your texture and temperature senses, to help you enjoy food and distinguish what is healthy from what is harmful.

As we reach middle age, taste perception begins to fade through loss of the papillae on the tongue that house them. That is unavoidable — but it is worth not accelerating it. I am in my late 60s — how can I keep my teeth in top condition? covers the rest of that period.

To keep your taste receptors in good condition:

  1. Avoid smoking
  2. Keep your tongue clean
  3. Avoid over-consumption of spicy foods

A fourth worth adding: keep your mouth from drying out. Taste depends on saliva dissolving what you eat, so dry mouth dulls it — and a sudden change in taste that does not settle is worth mentioning at your next appointment. Diabetes Australia lists altered taste among the oral complications of diabetes, and is candid that the underlying cause is not clear.

Common questions

Is there a screening program for oral cancer that I should be on?

No — and that absence is the whole reason a campaign has to tell you to watch your own mouth.

Australia runs national population screening programs for breast, bowel and cervical cancer, and more recently a National Lung Cancer Screening Program for people at highest risk. Cancer Council Australia's summary is that if you receive an invitation to screen, you should take the test. Oral cancer is not on that list, so no letter arrives and no register follows you up.

The reason is evidentiary rather than administrative. The RACGP review of oral cancer in general practice states that “to date, there is limited evidence to implement a formalised population oral cancer screening program, such as that for cervical cancer screening,” and concludes that “oral cancer screening is reliant on recording a thorough medical history and visual examination.”

That does not mean nothing is happening. Victoria's 2016–20 Cancer Plan established an Oral Cancer Screening and Prevention Program, run through Dental Health Services Victoria, precisely because — in Oral Health Victoria's words — “largely due to delayed presentation or diagnosis, oral cancer carries low survival rates.” Part of that work was an online training resource on the RACGP website to help GPs identify people at risk and detect the disease earlier.

What it means for you is simple. There is no system waiting to catch this, so the check happens because somebody performs it — at a dental examination, or at a GP appointment if you ask. If it has been years since anyone looked at your soft tissues rather than your teeth, that is the gap worth closing.

What does an oral cancer check actually involve?

Less equipment than people expect, and more of the mouth.

The RACGP review describes it plainly: screening “can be performed through a comprehensive oral cavity examination with readily available equipment, including gloves, a mouth mirror, a tongue depressor and a torch.” No scan, no biopsy at that stage, no special machine.

What gets examined is the part worth knowing, because it is broader than the mouth. The review specifies a thorough extraoral examination — face, jaw, chin and neck — and intraoral examination — lips, buccal, labial and lingual mucosa, attached gingiva, tongue, floor of the mouth, and the hard and soft palate. It also names where the risk concentrates: “the most high-risk sites for oral cancer are the lateral margins of the tongue and the floor of the mouth.” Those are the sides of the tongue and underneath it — neither of which you see when you smile at a mirror, and neither of which a quick look at your teeth covers.

On who does it: the review states this screening “can be conducted by GPs and dental professionals.” So it is a reasonable thing to ask for in either setting.

On who should have it done as a matter of course: “risk-associated screening should be done on a case-by-case basis for patients aged 45 years or over and for those who are current or past substance users (eg alcohol, tobacco or betel nut/quid).” Past counts, not only current.

You can do a useful version at home, monthly, with a torch and a mirror — lift the tongue, look along both of its edges, pull the lips and cheeks out, and run your fingers along the neck and under the jaw. You are looking for anything that is new and has not gone away, not for anything that hurts.

I do not smoke and barely drink. Does any of this apply to me?

Less, but not none — and there is a trend in the data that makes the question worth taking seriously rather than dismissing.

The established risk factors, as the RACGP review lists them, are age over 45 (especially in men), tobacco use, alcohol consumption, areca (betel) nut chewing and limited access to dental care. It also notes that areca nut chewing is a growing practice in Australia. If none of those describe you, your risk is genuinely lower.

But the same review flags something else directly: “an emerging subgroup of non-smoking and non-drinking middle-aged women with tongue cancers is also concerning.” That is the profile most people would assume is not at risk at all.

The Victorian Cancer Registry data points the same way. Between 2017 and 2023 the age-standardised incidence rate of oral and oropharyngeal cancer in Victorian females increased by an average of 3.2% per year. For males, the increase between 2008 and 2023 averaged 0.1% per year and was not statistically significant — meaning the change cannot confidently be considered real. So the rise is in women, not men.

There is better news alongside it: over the long run, age-standardised mortality declined by an average of 2.1% per year in males and 1.5% per year in females between 1982 and 2023.

The practical upshot is that “I'm not a smoker” is a reason to worry less, not a reason to skip a check or to wait out a persistent ulcer.

Why does my dentist ask about my general health?

Because the mouth is not sealed off from the rest of you, and the clearest worked example is gum disease and diabetes.

The review Periodontitis and diabetes: a two-way relationship, published in Diabetologia, sets out both directions. Diabetes raises the risk of gum disease: “susceptibility to periodontitis is increased by approximately threefold in people with diabetes,” with a clear relationship between how high blood glucose runs and how severe the gum disease is. And gum disease appears to act back on diabetes — treating periodontitis is associated with HbA1c reductions of approximately 0.4%, a figure confirmed in a Cochrane meta-analysis at three to four months after conventional periodontal treatment.

The consequences run further than the gums. The same review reports that macroalbuminuria and end-stage renal disease occur twofold and threefold more often in people with diabetes who also have severe periodontitis than in those without, and that the risk of cardiorenal mortality is around three times higher in that group.

For scale: it describes periodontitis as “highly prevalent (severe periodontitis affects 10–15% of adults).”

One structural gap is worth knowing about, because it means nobody else is likely to raise it with you. Diabetes Victoria notes that dental visits are not formally included in the Annual Cycle of Care for diabetes in Australia — the cycle covers blood pressure, HbA1c, cholesterol, kidney function, podiatry and eye examinations, but oral health is missing from the checklist. So if you have diabetes, the dental half of that picture is one you have to ask for.

The same logic is why the medical history matters generally: medications that dry the mouth, conditions that affect healing, smoking status, pregnancy, and treatment that suppresses immunity all change what happens in the mouth and what should be done about it. Bring the list. See diabetes and oral health and dental health and general wellbeing.

Related reading

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. The clinical team is listed by name, and fee ranges are in the price guide.

Published 8 August 2018. Dental Health Week is an Australian Dental Association campaign. Oral cancer screening and risk-factor material in the questions above is attributed to a review published by the Royal Australian College of General Practitioners, to Cancer Council Australia, and to Oral Health Victoria; incidence and mortality trends are from the Victorian Cancer Registry (2025) as published by Cancer Council Victoria and describe Victoria, not Australia as a whole. Periodontitis and diabetes figures are from a review published in Diabetologia and the Cochrane meta-analysis it cites, and describe those study populations. General information only; it does not replace advice from your treating practitioner.

Smile Solutions trades under ABN 28 193 514 103.

Images on This Page