How much toothpaste do we use?

Treora

Mod: I don't know if this is the right forum, please move as required.

I was writing a blog piece on Irish health and found out that the useful information is privately held. As I don't have the €350 in my back pocket could someone at uni see if they can reference, for educational purposes, the per capita consumption of toothpaste in Ireland. The report is:

"Toothpaste Market in Ireland to 2014 (Oral Hygiene)" the information is on tables 19 and 20

Tnx.

yobr

Why not ask these guys?

http://www.dentalhealth.ie/about/

Treora

yobr wrote: »

Why not ask these guys?

http://www.dentalhealth.ie/about/

I called them up. They were very polite, but vague. Saying that we get enough but can always do with more. And when I refered to the study, they said (in a round about way) that you would have to buy the report and they were not going to break copyright even if it was for educational purposes and was less than 5% (I think that was the educational threshold) of the report that was being referenced.

So now I turn to anyone who studies dentistry or has access to the report.

ballsymchugh

look up helen whelton in the dental hospital in UCC. this is right up her street.

btkm8unsl0w5r4

One of the large manufacturers such as GalaxoSmithKine or Colgate would have sale figures and marketing info. They might share.

Treora

Nope they don't share. Trade secrets and all that, hence why someone else went off and did consumer panels to build the report.

UCC dental hospital and dentalhealth.ie have similar board members. Again polite but vague.

Colgate and dentalhealth.ie fund school oral health campaigns, so UCC and dentalhealth.ie just refer you on to colgate if you want sales stats and they don't give out industry secrets. So...

Is anyone in college that might have access to the report from my OP.

Dianthus

If the blog is on Irish health, and the data on per capita usage of toothpaste isn't readily available, might be worth focusing on diet(sugar consumption)/oral hygiene(brushing, mouthwash, flossing frequency) aspect.
Dental hospitals may be more willing/able to release this information freely.
A recent lecture I attended (& I apologise in advance for not having references!) detailed:
- A quarter of 7 year old children in Ireland are either overweight or obese
- Prevalence of caries(decay) in ROI: 25% of preschoolers, 37-55% of 5 year olds, and 20% of 8 year olds.
- Only 50% of children brush their teeth, and only a third of these brush with a fluoride toothpaste.
Seeing a child in 2nd class(their first visit to the school dentist, and for many, their first ever dental visit) is too late for these children.
There was also some mention of dental decay being the most common chronic disease of children in the US (Ref CDC; Centers for Disease Control and Prevention)? Prob ROI isn't far off. And the most disheartening part is that it's all preventable.

Treora

Dianthus wrote: »

- Only 50% of children brush their teeth, and only a third of these brush with a fluoride toothpaste.

This is useful, do you have reference sites or the name of the lecturer. Thanks

Dianthus

PM sent with contact details

digzy

just follwing on dianthus post, if a little off topic......

I was on an overnight train in vietnam in 2001 with a few of my classmates. i couldn't believe in the morning when most of the passengers were out with their toothbrushes and paste.....and i get patients who leave empty bottles of coke/lucozade in my waiting room. it's have you wondering which one is the 1st/2nd world country:rolleyes:

any idiot knows that sugary drinks contribute to cavities. they also know that junk food makes you fat. yet we all see how much of this stuff is consumed in the 'developed' world. people make lifestyle choices despite knowing better! at the risk of sounding like a complete ignoramous....but i wonder why so many of these studies (oral health, diet etc.) are caried out. the public health policy message is still the same.

Esel

My dentist recommended a pea-sized amount - any more is just wasted.

@Mods: Sorry, couldn't resist...

Treora

I eventually got it off euromonitor.

The total national consumption of toothpaste is ~ €35,000,000 @ €15/ltr @ 3,500,000 people (3 million regular users, 1 million irregular users, 1/2 million excluded (under 3 or denture users)). The ideal amount is 182.5ml / capita or 2.4 75ml tubes per annum. The actual consumption is 670ml / capita or 9 75ml tubes per annum, which is a waste of 487.5ml per capita or €25,593,750 for the nation each year.

I thought the litre price was low, but the big brands are loosing out to the discounter brands, Tesco even sells 100ml for €0.75.


@Dianthus
You are right, correct use appears to be down to education. Ireland gets one national, industry sponsored, tooth day sometimes with a dentist or oral hygienist. Swedish children get habitual training every school day when children are 5 & 6 and the Swedish also target vulnerable people for specialised oral care - Värmland Needs-Related Caries Preventive Program. Most countries - including the UK - get 7 to 30 days of national oral hygiene promotion (including technique - both in school and on TV/websites). Saudi Arabia even sends every secondary school student in small groups off to the local dental academy (a combination seminar, tutorial, check-up and career guidance course).

Our country comparison for 'Decayed/Missing/Filled Teeth' (DMFT rate at age 12) shows Ireland in the bottom third <http://www.eudental.eu/index.php?ID=35918> at 1.1, which is a pretty decent level. The range is 0.7 to 1.4 with most European countries in the 0.9 to 1.05 range. We get compared to the USA for WHO/ADA advice but the USA has a DMFT rate of 2.85 at age 12 (table 4 <http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/DentalCariesAdolescents12to19.htm>).

It is almost always access (resources/services) and an education issue (sugar avoidance/oral hygiene). Sweden targets vulnerable people in the Värmland Needs-Related Caries Preventive Program <http://www.biomedcentral.com/content/pdf/1472-6831-6-S1-S7.pdf> with amazing success. The roughly 6,000 homeless in Ireland have a DMFT of 20+. Today a habitualise crutch by most on fluoridation has failed economically deprived areas (DMFT @ 12 of 2.35+) in funding allocation and dental needs equality. This is because multiple daily sugared soft drinks consumption counter acts all ambient fluoridation protection from fluoridated water. There is no benefit to the wider public from this policy of funding misuse as high dental education replaces water fluoridation with no ill effect according to a WHO report written by dental Professors Michael A. Lennon, Helen Whelton, Dennis O’Mullane & Jan Ekstrand <http://www.who.int/water_sanitation_health/dwq/nutrientsindw.pdf> page 183.

"countries, where public dental awareness is very high and alternative vehicles for fluoride (e.g. tooth paste) are widely available and widely used, a decision not to replace fluoride removed from the drinking water would be of no consequence"

As an example Innis Boffin uses mouth rinse over water fluoridation and has a DMFT < 1 due to its high oral education standard.

The €60m+ on the bureaucracy surrounding fluoridating water could be better spent on wider & higher quality education and funding for targeted intervention programmes.

ballsymchugh

Treora wrote: »

@Dianthus
You are right, correct use appears to be down to education. Ireland gets one national, industry sponsored, tooth day sometimes with a dentist or oral hygienist. Swedish children get habitual training every school day when children are 5 & 6 and the Swedish also target vulnerable people for specialised oral care - Värmland Needs-Related Caries Preventive Program. Most countries - including the UK - get 7 to 30 days of national oral hygiene promotion (including technique - both in school and on TV/websites). Saudi Arabia even sends every secondary school student in small groups off to the local dental academy (a combination seminar, tutorial, check-up and career guidance course).

demarcation and unions will prevent anything like that happening in this country anytime soon.

coylemj

Treora wrote: »

I thought the litre price was low, but the big brands are loosing out to the discounter brands, Tesco even sells 100ml for €0.75.

And the Pound shops sell grey market big brands e.g. a tube of regular white Colgate which appears to be manufactured for the market in Thailand is €1 in a discount shop in Dun Laoghaire vs. €1.49 for the home stuff in Dunnes.

Treora

ballsymchugh wrote: »

demarcation and unions will prevent anything like that happening in this country anytime soon.

I thought this too, but the Croke park agreement is putting on severe pressure along with the new water utility legislation. Teachers appear to be looking for any reasonable way of showing that they are saving the state money while not compromising themselves. Dental education might be an easy out, but some resource reallocation would be necessary. And that is the crunch part - funding is locked into the bureaucracy which is defended by the legislation. Not really the supple and adaptable joined up governance we had hoped.

peggie

hi op
i would like to make a brief observation on your comments re water fluoridation. i don't agree with your interpretation of the quote you gave from O'Mullane and co. i think your assumption that dental education can replace water fluoridation is incorrect. education may increase knowledge but it doesn't necessarily change behaviour.

educating the population about dental health habits doesn't have the impact you think it would have on decay levels- look up work done on this topic by Kay and Locker if you would like research on this

in the area of public health i think it is taken as a given that working on the social determinants of health and improving these will have bigger impact on all areas of health not just dental health. an example of this would include improving education in general as seen by supports in DEISE schools rather than education on dental habits.

it is also wrong to say irish children don't get education in dental health. while there is no set national minimum children do receive education in many ways. in some areas dental hygienists and oral health educators from the hse go to schools and give talks to children. also children receive dental health education at an individual level when seen by the hse dentists and private dentists. as there is no agreed set minimum you have decided it doesn't happen. the difficulty is that there are differences across hse areas due to staffing and resource issues


i hope these feedback is useful for you for your blog
best of luck
peg

Treora

Hi peg

Thanks for the feedback. I have been reading through the rest of the forum and there seems to be very strong views on some of the issues I address. I am writing on how to achieve the ideal outcome with the best use of resources in the area of national dental health from both the personal (toothpaste use) and public (education or visits) resource perspective.

peggie wrote: »

i don't agree with your interpretation of the quote you gave from O'Mullane and co.

I try not to interpret, I just to take it as it stands and it is reasonably clear in its message.

"countries, where public dental awareness is very high and alternative vehicles for fluoride (e.g. tooth paste) are widely available and widely used, a decision not to replace fluoride removed from the drinking water would be of no consequence"

The problem with Ireland is that our dental health awareness has suffered from the lack of a long term view towards education by any government.

peggie wrote: »

i think your assumption that dental education can replace water fluoridation is incorrect.

Can education replace water fluoridation?

I can only respect the experts, in this case the Council of European Dentists. Their statistics place Ireland in the bottom third of the DMFT @ 12 league table <http://www.eudental.eu/library/104/files/new_eu_manual_2009_version_41___aug010-20100827-1652.pdf>. They show dental education and fluoridation levels for comparison, though you have to work through the report to scrap out all the details (pun intended).

When Ireland had horrendus dental resource access up to the 1960s it made clear sense to fluoridate. Toothpaste was not widely available until roughly 1965. Access to toothpaste only entered the public consciousness when the legislation was enacted. People benefited from fluoridation when Dublin still had tenaments and the Ballymun towers were not even architectural plans.

This was all at a time when Prof O'Mullane was studying dentistry and undoubtedly confirmed his view which assumedly shaped how he mentored Prof Whelton and even they have acknowledge that it is possible to live without water fluoridation. I am just investigating what the most efficient and effective use of Irish resources for everyone's shared goal of good teeth at a time when Ireland will re-introduce property tax that has been dead and in the grave for 35 years. We all live in our own bounded rationality, but times change as does access to toothpaste and awareness on its proper use, Daniel Kahneman expresses it more elegantly.

peggie wrote: »

education may increase knowledge but it doesn't necessarily change behaviour.

Some education does not change behaviour - e.g. learning to reading. This does not make students avid readers, it only gives them the ability to read whatever they choose.

Habitualisation by education does change habits. Learning to drive and having an instructor repeatedly tell you to use the indicator will change your habits. In the classroom when the teacher asks your name in Irish almost everyone educated in an Irish primary school will say "anseo" even after many years of leaving school.

In Sweden children are in preschool at 5 & 6 to teach social norms and interaction before loading their brains with knowledge. Daily each class is brought through the practise of dental care. After eating they rinse out their mouths with water to remove some sugars & bacteria and partially neutralise the acids with water. They then brush their teeth in a state proscribed manner. Some classes have Barney like videos to follow. Then the social determinant factor is addressed. Parents are given information cards with brushing technique and a twice daily tick off chart - this is their only homework. This practice and attitude positively reinforces oral hygiene as behaviourally transformation for the entire nation. Sort of like establishing a cultural value through preschool teachers. It is also used as a positive discipline tool to help parents bring structure into their parenting role, this is essential to households that have lost structure (normally this is a big push on the immigrant community to normalise and integrate into the Swedish cultural view on the role and position of the parent as a positive educator rather than a negative discipling figure. That said many public Swedish dentist still use the scrapper as their primary tool! I guess they are not as good as Irish dentists

peggie wrote: »

while there is no set national minimum children do receive education in many ways. in some areas dental hygienists and oral health educators from the hse go to schools and give talks to children.... the difficulty is that there are differences across hse areas due to staffing and resource issues

You are right - some children in Ireland get excellent dental education, but others don't. I recognised that a few lucky students benefit from visits by dentists. I see a curriculum or a national strategy on dental education that addresses the goal of oral health care equalisation as the responsibility of the government, which they currently attempt exclusively through water fluoridation. We don't even have a chief dental officer in the department of health. Where is the money being spent?

You are right it is an issue of resources and funding. A factor is the costly bureaucracy that Ireland is legislatively bound and ideologically fixed to retaining in a time when creative answers are required to solve the problem of diminishing resources. Junior/senior infants teachers teaching a proscribed oral care system would fulfil their Croke park agreement mandate for increased productivity and leave the child with the correct brushing technique and a positive habit.

peggie wrote: »

hi op
educating the population about dental health habits doesn't have the impact you think it would have

Most countries use national dental week/month as part of their national oral care strategy. Normally this is more a reminder tool like ambient advertising. Currently oral cancer awareness and national tooth day are fighting each other for funds and are on opposite sides of the calendar. However soft drink manufacturers use advertising to great effect, otherwise they would not spent so much money on advertising. Now that we realise the affects of advertising on children, the banning of certain foods during children's TV time, it is time for positive behavioural advertising. A daily ad during a national dental month during children's TV hours might turn children into positive reinforcers on the habits on their parents. The opposite of sweets beside checkout tills. Road safety campaigns have been run on this premise - the most recent was motorcycle safety in Ireland and the RSA asked car drivers to see the child of the motorcyclist and not just the driver. The UK also has a very witty one (below). I hope you agree that advertising affects behaviour, even if it takes time.

<The "New Dad" sign is so twee but also so cute>

peggie wrote: »

i hope these feedback is useful for you for your blog
best of luck
peg

Thanks it has been, addressing your points focuses the whole premis. Please let me know if I am biasing the issue. I have see too much unsubstantiated polarisation of views on this issue through out the forum and want to give a fair reflection of the situation, the article will have more from the traditional dental view with supporting evidence.

Big_G

What you seem to be getting at here is using the money currently being spent to create an educational system that spoon feeds children behavioural alteration techniques and habitualisation. I'm all for it if it produces the desired results.
Several points, the quote that is central to your idea shows that you cannot remove fluoride until all the other systems are in place, then it wouldn't be missed. Therefore the budget would have to be doubled for about half a generation in order to begin to see benefits (older children will be more difficult to habitualise).

Secondly, Sweden is not a great country with which to compare Ireland as they have an extremely narrow wealth gap which results in a lower variation in health outcomes. This is a known entity in healthcare economics, wealth distribution and narrow wealth gaps result in better overall health, especially at the bottom end of the curve.

Apart from that, have at it. I wouldn't like to be the teacher that has to tell parents that they need to make sure their children brush their teeth....

Treora

Big_G wrote: »

What you seem to be getting at here is using the money currently being spent to create an educational system that spoon feeds children behavioural alteration techniques and habitualisation. I'm all for it if it produces the desired results.

Thanks for the support, many people have criticised that train of though as being too authoritarian. Ireland is moving from de jure common law to de facto civil code system. Where personal responsibility and common sense were met with a free hand until the government told us to stop. Now the EU produces 75% of our law, where other EU nations have high active citizens (think French protesters) we have changed to a litigious society placing blame on everyone else, which is where clarity of action and responsibility from government might help. Some positive compulsion transparently presented for worthy good is better than our normal national prohibitionary stance.

Big_G wrote: »

the quote that is central to your idea shows that you cannot remove fluoride until all the other systems are in place, then it wouldn't be missed.

True, but I believe the pros outweigh the cons and with technology improving survey accuracy in real time we can benefit from a more defined tipping point.

Big_G wrote: »

Therefore the budget would have to be doubled for about half a generation in order to begin to see benefits

An increase yes, but gaining from other countries experiences will help us keep our costs down. This front loading for long term benefit is what is happening with water meter installations and property tax registration. This would be arguably be less devisive and more beneficial especially considering our demographics (lots of babies born in 2010/1). The water services bill is an opportune moment to display how lazy habits will come back to haunt and harm you. Just look at Ireland's water pipe infrastructure. And how good habits will reduce future dental costs.

Big_G wrote: »

(older children will be more difficult to habitualise).

You are spot on. Who wants to motivate young teenagers, but is can be done? But here is how teenagers can be swayed.

Celebrities

or Kittens

I don't care for the messages either way, but short well produced videos (designed to look home made) have massive hit rates. Changing habits is best done by those teenagers already look to emulate. "girls brush right and be happy like me" "guys if you ever want a chance with a girl like me brush right"

Big_G wrote: »

Sweden is not a great country with which to compare Ireland as they have an extremely narrow wealth gap which results in a lower variation in health outcomes.

You might be right, but Sweden is more of a target than a direct comparison. It was the other 17 countries that placed better than Ireland against which we can compare. As an aid to the process we could use Germany's fluoridate salt option. Mandate fast food outlets to use it and subsidise it in areas with high DMFT @ 12. Salt sticks to the tongue even after soft drinks wash everything down. Fluoride's negative ions are there when the sugar feeds the oral bacteria and can neutralise the acid as it is created stopping erosion and preventing plaque.

Big_G wrote: »

I wouldn't like to be the teacher that has to tell parents that they need to make sure their children brush their teeth....

I'm with you on that. Habitualised senior infant oral care would be developed as a parent skill initiative. There are so many TV child psychologists that would love a universal aid that every parent could relate and understand to clarify positive parental authority and give coherence between school and home. The children would see it as a competition or approval mechanism.

I also see it as a tool for providing routine to distended or separated families. If the tooth card was provided as an app then parents can keep a routine with their children even if Monday to Friday is with one parent and the weekend with another with eating, sleeping times, homework and manners all differ.

The vital thing is that this system is not turned into the fiasco of communications, design and execution that is the property registration/household charge.

Big_G wrote: »

Apart from that, have at it.

Thanks for the endorsement, getting traction and numbers on research blogs is not easy these days.
Cheers