Dental professionals have been urged to reconsider how they manage patients who appear disengaged with their oral health, with a rallying call to “exhaust every option” before considering palliative care.

Speaking at the launch of National Smile Month 2025, Rhiannon Jones, a dental therapist and president of the British Society of Dental Hygiene and Therapy (BSDHT), challenged clinicians to reframe their approach to patients who are often considered ‘non-engaging’. She also encouraged attendees to take a second look at adjuncts like mouthwash as essential elements of routine care.

Rhiannon said, “Before we consider moving a patient to palliative care, we must ask: have we exhausted all options? If we haven’t explored adjuncts like mouthwashes – especially those with essential oils or cetylpyridinium chloride – then we haven’t done everything possible to help patients manage their oral health.”

Rhiannon, who currently in practises in Wales, delivered her remarks as part of a keynote address at the event. Her speech resonated with clinicians and oral health advocates alike, as she encouraged a more open dialogue with patients and the inclusion of evidence-based adjuncts in care planning.

She continued, “I’ve seen our profession evolve, and National Smile Month evolve with it. But one thing that hasn’t changed is the need to reach every patient. For those who aren’t engaging, we must ask better questions and offer more tools, not just fall back on the assumption that they’ve failed.”

Rhiannon highlighted new European guidelines from the EFP and ESP, which define and frame the term ‘non-engaging’, offering an opportunity for more structured interventions.

Rhiannon argued strongly for the wider integration of mouthwash as an active clinical tool, particularly for patients who may struggle with mechanical plaque removal due to age, disability, cognitive decline, or other limiting factors.

Rhiannon added, “We need to challenge our assumptions about mouthwashes. They’re not just breath fresheners. They’re therapeutic agents backed by solid evidence. Mouth rinses, especially those with fluoride or antimicrobials, can reach areas brushes cannot and can reduce inflammation and control biofilm more effectively than brushing alone in some cases.”

Nigel Carter, chief executive of the Oral Health Foundation, echoed Rhiannon’s sentiments and called for mouthwash to be repositioned as a core part of the oral health conversation, both in the clinic and at home.

He said, “A patient’s home routine is fundamentally linked to their oral health status. The key to developing and maintaining good oral health is effective daily plaque removal that can be independently achieved by the patient.”

Nigel warned that while brushing and interdental cleaning remain foundational, they are often not enough. He added, “While mechanical cleaning dislodges plaque bacteria, data suggests that this is not enough in a majority of people to maintain good levels of oral health. Therefore, as an addition to brushing and interdental cleaning, we would recommend the use of an effective antimicrobial mouthwash.”

As part of National Smile Month’s 2025 theme, ‘Feed Your Smile’, the Oral Health Foundation has called for a holistic, evidence-led approach to preventive care, including diet, hygiene, and adjunctive support like mouthwash, to tackle ongoing oral health inequalities.

For more information visit www.smilemonth.org

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