Oral Grooming: an Evolutionary Perspective - A New Model for Oral Health and Wellbeing*
Kevin Scally

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 orally groomed.

The outcome is a debrided mucosa and tooth surface; and, with that, the removal of the bolus of pathogenic supragingival bacterial plaque.

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 pastes.

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 plaque removal.

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