Without the dentist, the next best thing is gargling salt water

Lockdown has meant that many of the services we used to access outside the home have had to become DIY. We’ve all got used to cooking all our own meals again, instead of heading for a cheeky Nando’s when inspiration fails to strike at the fridge door. I’ve found joy in cleaning my own windows (though only until the sun shows up the streaks). Many people have taken a crash course in cutting their own hair. I can manage a passable manicure these days, even with my left hand. But there’s one area of personal care where most of us hope never to have to do it ourselves. That’s dentistry.

When lockdown began, dental surgeries closed along with everything else. But dental emergencies continued to arise of course, and, unlike an overdue haircut, they could not be left unattended.

Two days into our time of confinement, my friend developed a problem with her molars. A piece of trapped food (she suspected) had given rise to a nasty infection in her gums. My friend’s dentist referred her to another surgery run by the same private medical firm. They referred her straight to NHS 111. Three hours on hold to 111 later, my friend was told her only option was to go to the dental department at a nearby general hospital. By now it was late afternoon and the hospital’s voicemail advised her to try calling at eight the following morning in the hope of getting an appointment at some time in the next few years. At eight the following morning, the hospital’s phone was already engaged and remained so for hours on end. All the time, my friend’s agony was increasing as the infection in her gums raged. So she took matters into her own hands and turned to a distinctly medieval solution. No. Not the pliers... She began to use a salt-water gargle.

Gargling with salt water for toothache and gum pain is nothing new. There are references to the practice in papyrus scrolls from Ancient Egypt dating from 1600BC. The Ancient Greeks too were convinced of salt’s power to stop infection. In the medical volume of his Natural History the Roman author Pliny the Elder, writing in the first century AD, recommended the practice. But then the Ancient Egyptians also used mouldy bread and horse’s saliva in their medicine, while the Ancient Greeks were fond of a bit of trepanning (drilling holes in the head). And apart from salt water, Pliny the Elder also suggested that toothache, “may be cured by using the ashes of the head of a dog that has died in a state of madness… and the ashes injected with oil of Cyprus into the ear on the side affected.” Hmmm. If you couldn’t get hold of a mad dog, Pliny said you could use earthworms in a pinch.

So, bearing this in mind, should a salt-water mouth rinse be regarded with the same suspicion as eating a whole mouse twice a month in lieu of visiting the dental hygienist (Yep. That’s Pliny the Elder again. He had some cracking ideas about oral health)? How does it actually work?

There are a couple of theories. One is that, via the process of osmosis whereby water is drawn from one side of a permeable membrane to the other, salt solutions can draw bacteria to the surface of the gums so that they can be rinsed away. Another theory is that a salt water rinse alters the PH level of the mouth, making it more alkaline, thus creating an inhospitable habitat for bacteria, preventing their reproduction.

Though the concept of using salt as infection control has been around for millennia, there hasn’t actually been much recent scientific research into the effectiveness of a salt water rinse on oral health. However, a couple of studies from the past decade have shown small positive results. A 2010 study of 45 children published by the Journal of Indian Society of Pedodontics and Preventive dentistry, found that rinsing with salt water reduces levels of dental plaque and eliminates the microbes thought to cause gum disease.

In 2016, a joint study by researchers from Thailand and the Netherlands, showed that applied in vitro, a saline solution promoted biological processes known to be important to wound healing. They concluded that their “data provide the first scientific evidence to support the application of salt solution as mouth rinse in conjunction with routine oral care to promote oral wound healing.” Still other studies have shown benefits from salt water gargling with respect to preventing upper respiratory infections, such as colds and sinus infections.

It is likely that had my friend ever been able to talk to a dentist, a salt water rinse might have been the temporary solution they actually suggested. A salt water rinse is often recommended to help aid recovery after dental surgery, because salt water has a lower risk of irritating the mucous membranes of the mouth than conventional shop-bought mouthwash.

A number of dentists’ websites recommend making a salt water rinse by adding between half and three-quarters of a teaspoon of salt to a glass of lukewarm water. In the case of an infection, you begin by rinsing every two to three hours, before dropping back to three or four times a day. You simply swirl the salt-water solution around your mouth then spit it out. Whatever you do, don’t forget to spit it out! A salt-water rinse can be used to control inflammation for two to three weeks while looking for a more suitable long-term solution, such as an alcohol-free mouthwash with fluoride.

Eventually, my friend was able to get through to her GP, who told her that while GPs are not strictly supposed to prescribe for a dental emergency – that’s a dentist’s job – under the circumstances, he would prescribe antibiotics. In the end, my friend decided to continue with the salt-water mouthwash instead and has kept her gum infection under control ever since. She still needs to see as dentist as soon as possible, to address the underlying cause of the problem, but at least she’s not in agony for the moment.

While dental surgeries remain closed, and some dentists have even resorted to suggesting their clients try such interesting methods of pain control as using the wax coating from a Babybel cheese as a substitute for a temporary filling (I suppose it makes sense. When I had a brace, I always thought the dental wax I was given looked like it belonged around an industrial cheese) perhaps it’s worth stocking up on a little more salt next time you’re in the supermarket. Assuming you can’t find the ashes of the head of a mad dog and are too squeamish to eat a couple of mice.