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Oral Grooming: an Evolutionary Perspective - A
New Model for Oral Health and Wellbeing*
It has been observed that chimpanzees groom each
other's mouths, removing material from between the teeth.
An essential feature of primate behaviour (and humans
are primates) is grooming. At a pragmatic level, this is seen as a way
of maintaining skin health with the removal of external parasites. However, there is a deeper level, who grooms
who and how often has a lot to do with social status and the maintenance
of social bonding between individuals.
In a feral condition, food impaction has a devastating
consequence on the dentition - periodontal abscess formation and unilateral
crippling of chewing ability. For a feral animal, where the rule is 'when
your teeth wear out or when you become orally crippled, you die',
any behaviour that circumvents or addresses this is of significant
survival value. An evolutionary biological argument can be put forward
that the pleasure derived from tooth picks or floss when dealing with food
impaction is an evolutionary advantageous phenomenon in that it allows
the 'patient' to tolerate something being done to mouth and gingiva.
So, it could be argued, that the great apes are
genetically pre-programmed to be oral health care workers. They don't
need state sanctioning to look after each other. If they were in the
Australian State of Victoria, they would be breaking the law.
Using the evolutionary biological model, the resources
given by the brain to the sensory input from the mouth, lips, and teeth,
tongue, suggests this area is of special importance. Likewise, any
trauma to this area will make a significant impact on the psyche. With
the first experience of oral grooming often being an oral invasion, with
injections, sounds, strange tastes, and pain, the effect can often be a
deep-seated fear and phobic response.
Looked at an other way, what self respecting animal
programmed for survival would voluntarily allow another member of its
species (often male, often an older male) invade the delicate and
sensitive oral cavity?
So how to remedy this supposed aetiology of phobia to
dentistry and dental treatment in the public consciousness?
The obvious is to go with what is already established
within us: the expectation and desire to be orally groomed and to groom.
Dentistry as an experience, could be changed if the
experience of oral care delivered by another was an enjoyable and
pleasurable experience like a massage or a haircut.
Teaching care givers of intellectually challenged,
dependent, and paediatric patients to use the grooming model, in my
experience, completely changes both the carers' attitude and compliance
in grooming a mouth, and the experience and compliance of a person being
The outcome is a debrided mucosa and tooth surface; and,
with that, the removal of the bolus of pathogenic supragingival bacterial
How can this be applied to improve oral health?
Caries is a chronic disease. The secret is to diagnose
the disease early so self help procedures can be put in place to prevent
the situation getting worse, such as: topical fluoride, tooth pastes,
special trays that can be used for mouth guards and for topical fluoride
application, the application of fluoride varnishes and self applied
fissure sealing, and more recently, the introduction of calcium
phosphopeptide gels, creams, chewing gums, artificial salivas, and tooth
An Oral Groomer could work in a variety of situations.
In association with colleagues in the beauty industry removing
superficial enamel stains, giving oral health advise, and alerting the
client to things that may need to be checked by a more highly trained
oral health care professional. They could work in the Geriatric and
Special Needs dentistry teaching and instructing staff in oral grooming
philosophy and application. They could also be
employed in private dental practice to complement the dentist, dental
therapist, and hygienist.
For more information go to the following website for
ideas on plaque and the oral ecosystem and what we are trying to do with
Palliative Oral Care of the Terminally Ill Patient www.hospital-dentistry.org.nz/hospitaldentistry/papers/001.htm
*Briefing paper prepared at the request of the
Minister of Health, the Honorable Annette King, for the Dental Therapy
Workforce Technical Advisory Group 1999-2000