Facts and Myths about Oral Health: A conversation with PTS President Prof. Marzena Dominiak. Episode 93

Monika Rachtan
Hi Monika Rachtan, I would like to welcome you very warmly to the next episode of After First Patients. It's March, which means it's Oral Health Month. Today I'm going to talk about why it's important to take care of your oral health and how it translates into the health of our whole body. Poland says A and checks the health of its teeth. And my guest, but above all your guest, is Professor Marzena Dominiak. Good morning, Professor.

Marzena Dominiak
Good morning, and a very warm welcome.

Monika Rachtan
She is vice-chancellor of the Medical University of Wrocław and president of the Polish Dental Association, but above all she is a practitioner who also sees patients in the practice.

Marzena Dominiak
Yes, exactly. All the time, this is the best information about the doctor who is still there for the patient, because he can respond to the social needs that are emerging, the health needs and what is actually changing.

Monika Rachtan
The health of the oral cavity also speaks volumes about our entire organism. The statement is often used that the oral cavity is such a mirror of our body. And what do you see in your patients when you look into the mouth? And I am not just thinking of whether there is decay or whether there are any cavities, but in the context of the patient's entire organism.

Marzena Dominiak
I would even start with dental caries, because we have to pay attention to dental caries, not from the perspective of surgical medicine, which means that we do a procedure because there is a cavity, but we have to pay attention to the fact that it occurs for some reason. Of course, one element may be poor oral hygiene, but the other element may be a poor diet. That diet, which may be qualitative in quantity. And that can be a reason such that if you combine one factor or two factors on top of that, this caries can be flourishing. There can be a lot of it, it's often something that happens in children. For example, eating an apple as the last meal will often result in more than just acids, sticky foods or possibly sweetened drinks that will cause this decay to occur and that for us is already the first symptom, it means that we probably have an incorrect diet or incorrect brushing. Looking further, going to periodontal disease it's sort of a reflection of metabolic disease. So, if we have diabetes, we are more likely to have periodontal disease in the form of inflammatory changes, which will appear, popularly known as periodontitis, periodontitis, which develops and then there is redness, there is soreness, there is bleeding, there are loose teeth, sometimes these teeth change position.

Marzena Dominiak
Patients come in because, for example, they say I've moved a single tooth. Well it was so nice, I had a nice smile, and now something is starting to happen. So if we see periodontal disease, it should be such a red light that says ok, that means that this patient must have something wrong with their general condition. And the first question that may arise actually. What is your glucose level? Are you not suffering from. Just diabetes? How about your insulin levels?

Monika Rachtan
So that is why dentists ask us these questions. The kind of questions that you would think would be assigned to other specialities to a primary care doctor, to a diabetologist. And yet this question in the interview, once the dentist has seen the mouth, very often comes up, and it is because this is where we have a great deal of information in our mouth about what state our body is in.

Marzena Dominiak
Exactly so. That is one of the symptoms. As I said, we can see in the course of various other metabolic diseases, such as hypertension, such as there will be thyroid disease, that other metabolic diseases will appear, because they are the result of often such oxidative stress and some changes in the body somewhere we have to see. So either we need to examine the blood count, do a blood count test, or we can do an ultrasound or any other additional tests. Whereas here, even talking to the patient, we can see that if there is periodontal disease, that's the first signal of well there's probably something going on, so that can be a directional for the doctor that there's probably something going on and we're not going to cure that periodontal disease if the patient is not looked after and aligned with, for example, diabetes. Or the other way around for the PCP if there is periodontal disease, well they can look for it, they can ask the patient, because maybe it's the first time, because often patients don't even know they have a glucose disorder and they just walk around with that condition.

Monika Rachtan
Professor, and it often happens that you are the first specialist who catches such abnormalities precisely on the basis of the state of the oral cavity, that the patient, well, he has not been to a diabetologist, nor to a family doctor, but comes to see the professor because he has this popular hole in the tooth, and the professor says oh, dear patient, I see abnormalities here, you happen to be the first.

Marzena Dominiak
It happens to be the first, and often patients are surprised No as this dentist, because I have actually come because of a tooth or a missing tooth, and it suddenly turns out that we are talking quite deeply about the patient's general condition. But in addition to these visible changes, that is caries and periodontal disease, sometimes we have invisible ones, because the patient loses a tooth for various reasons. And now he comes in for an implant. And now it is an intervention. We do a certain procedure that induces an inflammatory process. If we have an already existing inflammation in the bone tissue precisely as a result of the so-called steatosis that occurs, this healing process will not be correct. We prolong this inflammation. And such a correct course is, we can say, the course of surgery is 5 days, and if it lasts longer, it is already the so-called negative inflammation. And now this steatosis, this steatosis is such a symptom of these metabolic diseases that appear and it is the dentist who can do the fastest, can thus recognise. Why? Because patients come to the dentist, we can say as often as to the PCPs. So we are the kind of professional group that sees patients most often.

Marzena Dominiak
And very often we take X-rays for dental diagnosis. But the basis of a correct radiological diagnosis is not just to see this one tooth or this one place. It is only if we already order this diagnosis that we have to look at what can be seen, i.e. the jaw, the mandible, the teeth, the temporomandibular joints or other structures that are visualised depending on what the imaging area is. And one of the elements we can assess the bone density. And if this bone density either in greyscale or we can clarify it, because there are such programmes and visually for the patient it is very good if we have this programme, because for example the centre of the bone should be so green and blue with red dots. If it turns out to be all red, it means there has been an inhibition of osteogenesis and there is fat accumulation in that area. And where this can be seen by a general practitioner such as an orthopaedic surgeon. In the spine, these lesions are referred to as these type 1-2-3 lesions. And the equivalent of this is just the bone, the jaw, the mandible. And now combining imaging with the frequency of the patient's vision, we can pick that up very quickly.

Marzena Dominiak
And now asking the patient how I see this photo with the photo, the need to do such a patient consultation. Sometimes the patient seems surprised And how do you know that I have a problem? Well I have this slight hypertension, oh that kind of thing there. And if I ask about my cholesterol level? But for you, what is it for? And it just translates very simply into what we see and sometimes we pick up these first changes with which we can refer the patient to a general practitioner, an internist or another specialist, often an endocrinologist, because without a balanced general condition, a dentist, especially a periodontist, an oral surgeon or a surgical surgeon maybe broadly speaking, shouldn't do any procedures because they're going to get involved or a dry symptom. This is a very common question. For example, a patient comes to the dentist and says You know, Doctor, Doctor, I tend to have dry pits and I'll always have an eighth graft after an extraction most of the time. And it's NOTHING more confusing that it's not the tendency, it's this situation related to this steatosis, because that's where most of the spongy bone is. These are often the first symptoms, not healing.

Marzena Dominiak
It stems from something. Our organism has this potential for self-regeneration, so if there is something disturbed, some kind of balance, then this is how it happens. And this understanding of these symptoms is very important, because at this level we can already detect a great deal.

Monika Rachtan
Professor, it is March, it is the month of oral health, there is a national campaign of the Polish Dental Association Poland says A, which actually lasts the whole year, But in March all these activities, all these projects are very intensive. Actions appear which are supposed to encourage us to this prevention. One of these actions is Healthy Smile with Oral B and the declaration of the organisation of 2.5 thousand visits throughout Poland, precisely to dentists, where we will be able to assess the health of our oral cavity. What are your observations? Do Poles willingly go to the dentist, and do you actually see such an increased mobilisation and motivation to take care of their smile in March, for example at your surgery?

Marzena Dominiak
I have to say that, as president of the Polish Dental Association, we have been trying for many years to publicise this action as much as possible in Poland. That is why we have translated To Poland Speaks A into Polish, i.e. we open our mouths wide. The World Dental Federation, on the other hand, is the creator of the action on a global level and 20 March is the day on which we talk about this oral health all over the world. Just as surely as other world days related to particular diseases are happening. This day is dedicated to oral health, but at different times we have different such slogans and for this year the World Dental Federation has provided a slogan which is in English Happy mouth is better mental health and well-being. So that's the kind of phrase that shows us, it links oral health to general health. It's such a guiding mission where we want to show what's going on and by inviting patients to the dentist we want to look at what's going on from one side. That is why there are free oral check-ups. It is thanks to the partnership of the Polish Dental Association of Oral B. In addition to that, there are talks with hygienists and talk about proper oral hygiene, because it is crucial so that we can differentiate what is the root cause of oral lesions.

Marzena Dominiak
Because the other such very interesting campaign that we at the Medical University have already started a year and a half ago is a campaign called Taking Courage. This is a campaign where we talk about obesity. Well, and now we can think about what this obesity and this dentistry have in common. It turns out that the course of obesity leads to changes that are linked, among other things, precisely to the deflation of the bone marrow that we were talking about earlier. Steatosis of the internal organs. Excessive fat accumulation in the palate, for example, occurs. And from there it is very common for dentists to take grafts, for example to cover exposed tooth necks. And now we have quite often these problems with the different procedures that we do within dentistry, with the different treatments whether implant or orthodontic, and it's messing things up for us. But with this obesity, it's not just these symptoms that we're talking about, because in obesity, according to a publication last year that was published in the Lancet, we have three main areas of complications that we're talking about. The first is the metabolic diseases that were mentioned earlier. The second group are the so-called mechanical symptoms, which are related to spinal problems or sleep apnoea, among others.

Marzena Dominiak
And the third is so-called mental problems, behavioural problems, problems, even sometimes with nutrition. And now this FDI slogan very much connects and shows this multifacetedness, in which this obesity is so popular in the world in the same incidence as caries. And I will stress again that this caries. I don't want you to understand that we have cavities, we get treated at the dentist, because it's like going not to the ophthalmologist we have problems with our vision. We get glasses, but we are not talking about this method of corrective action, we are talking about reading the symptoms. So this obesity is an element that affects the general health of our whole body. In that it actually also shows up in oral symptoms and translating into that will also affect the state of the gastrointestinal microbiota which can change and that translates into behavioural related illnesses just psychological illnesses depressions that also develop and without oral health, the course of periodontal disease we will not be able to achieve that health in terms of psychological and psychiatric health as well. If we can say I don't want to mention all the other aspects here, because there are doctors who deal with this.

Marzena Dominiak
On the other hand, this coincidence is occurring and we cannot reach a consensus without it. Health.

Monika Rachtan
But also without the cooperation of many specialists. I would just like to add that the professor talked about these three segments of obesity complications. In order to make our viewers more aware, I would like to say that the literature mentions more than 200 of these complications of obesity, so 200 different diseases can actually be caused by obesity. I have already used the statement several times in this programme that if we won the battle against obesity, many doctors would be able to close their surgeries because certain conditions would not exist. For example, such as type two diabetes, which is most often the result of our lifestyle. But what you said, Professor, about the health of our mouth and the health of our body, and how we look, but also how healthy we are, because obesity is a disease, it is all connected. And in order to treat it properly and not even to treat it, but to function in good health, cooperation is important. Cooperation between the doctor and the patient is important, but cooperation between specialists is also important, because the treatment of obesity may begin in the dentist's surgery, but then also involves other doctors, such as a diabetologist, a primary care doctor and a cardiologist.

Monika Rachtan
And now the Gaining Courage campaign has just brought together a number of different specialists. And in fact, in the system, in the Polish health care system, is this cooperation over a patient who is struggling with a disease such as obesity present? Do we still have much to do here?

Marzena Dominiak
Well, it seems to me that, on the one hand, we could say that we have, because already many, many professional groups are starting to pay attention to it, so I am already very happy about that. So much has already changed that we often already talk about this problem, but now we have to put it all together, to establish certain algorithms for dealing with it, and I think it is important to distinguish here, or rather certainly to distinguish between overweight and obesity. And to emphasise that we are talking here about prevention, diagnosis and treatment of the disease. This obesity, because it is known that this is the most difficult. But we always say prevention is better than cure. So this first stage and this year's campaign just now. What I would like to draw your attention to is a conference which we are organising at the Medical University for the second time in the Parliament. This time with the very nice slogan Let's be healthy.

Monika Rachtan
Professor, we have organised, we are a day after the conference.

Marzena Dominiak
We have well organised a conference in the Sejm with this title, slogan, acronym Let's be healthy is health. This is an acronym that is formed from the first letters of the words z. Like health, d for diet. R for movement. O as responsibility W as inspiration w as knowledge and as inspiration. This gives rise to the slogan healthy. And here in these individual panels we talked about what is such a central theme, that is, we talked about what health actually is, how we can build it. Of course, from a biological point of view we know, but the important thing is how to translate that into practice. That is why we talked about education. We talked about health education, about educating preventionists, maybe even for obesity. How this is an important pedagogy so that these preventionists can go into schools and educate properly, so that we can talk about it in a correct and professional way. And that's kind of the most important thing in all of this. Later on how diet affects all of this, Because diet just doesn't mean diet as diet, it means nutrition. And it is very important here to look very broadly, both from food law and from food producers, from what we eat, what we look for on the shelves, how these products are labelled, what we can see on this labelling.

Marzena Dominiak
Perhaps we should change something And this is an extremely important whole situation. So how is this plate built? Because it also determines what this weight of ours will look like later on. What are the right times to eat? What do we eat? So it's like very, very significantly important. What foods do we have? Just, for example, sweetened drinks or trans fats, which are present, which we sometimes forget, that the calorie ratio can sometimes be like 100 grams of crisps. That's according to your professor's formula. It's like 52 teaspoons of sugar in a glass of tea. So for a potential person who comes to the surgery without that knowledge, this is very telling information that we have tried to give you. In addition, we talk about proper exercise, which exercise or any sport that we do, even though it is actually exciting. Every. But for bone marrow rejuvenation, axial loading of the spine is important, and that with the correct rate of movement. There are scientific publications available of which we know that movement at a pace of 5 kilometres per hour is only appropriate, not 3. That is, not slow walking, but fast movement.

Marzena Dominiak
When does it get to such a strain and we should walk at least 20 kilometres a week? And, of course, responsibility. This is a very important element in which we have talked. What are you talking about, editor? Just about responsibility and publicity. What can we see?

Monika Rachtan
Yes, this is very important in terms of what we see in the media, what we see on TV, but also what we see in podcasts, what we listen to on the radio. And for me it's very frightening in terms of obesity that there are still, on television, between strands that are strictly aimed at children, there are adverts for a popular restaurant chain that serves meal kits that are 1,500 calories each, and unfortunately they also appear on public television, which absolutely should not be the case, so I miss that consistency in all of this. But what we were talking about at the conference in terms of our holistic health, starting with our mouth and going through our whole body, I think there needs to be some kind of systemic change, because all these discussions, introducing, for example, 20 kilometres a week, is something which is a big process, which requires commitment, not from the patient himself, but from the healthy person, but it really requires a huge change in lifestyle, because we are working eight hours at a time and commuting an hour to work and coming back an hour later, we have trouble preparing healthy meals for the next day.

Monika Rachtan
It is difficult for us to move regularly, and to move properly is a huge effort. So it seems that something has to happen here with our lifestyles, from the top down, to make all this possible. Because I think it would be difficult for an ordinary person.

Marzena Dominiak
Surely this systemic change is needed, and that is where our meeting and the recommendations that have been developed come from. After each panel, which we are submitting just from individual ministries, which we want in this entire group of invited guests, who are representatives of both federation societies, universities, MPs, politicians, as well as all influencers, because such a group has actually appeared, we can actually work out together some changes that would be valuable to introduce in the entire system, not only in health care, but in our entire way of education. The sooner we start educating and acquiring, I mean forming habits in the youngest generation, the better. This will later translate into proper functioning in the adult world. I know that this is difficult and takes time, especially for adults. You probably have to start with the smallest steps, so the simplest, easiest things can be chosen by individual patients who, for example, come to the dentist.

Monika Rachtan
Well, but it is this change that we talk about all the time that takes time and commitment. However, when it comes to brushing our teeth, well, it is very simple. We can do it today by actually standing in front of a mirror and focusing a little on how we brush our teeth. Because of course we have certain conditions, certain dependencies that are conditions of our body, but actually a lot depends on us, which is how we brush these teeth. Well, we just do it every day. We should do it after every meal.

Marzena Dominiak
We should be brushing at least twice a day, for two minutes we can say, and twice a year we should be at the dentist. And just paying attention to a little big thing like that can make us feel a change, an improvement, we will feel better, we will be more well-groomed, there will be a nicer smile, we will laugh more widely, we will laugh, and that will also affect our overall well-being. So if we reach for a toothbrush, we are able to improve not only our health, but also our smile and our everyday life. And feel that we have made a difference to our lives.

Monika Rachtan
Professor, when do we go to the drugstore? There are a lot of these things on the shelves. It's difficult for us to choose, because of course there are all sorts of substances in the recommendations, like just which toothpaste to choose, how it should be, how the toothbrush should be built. But when we go into that shop and there are so many of these things, it's hard for us to sort of keep track of it all, to sort out that knowledge. So I wanted to ask, is it better to choose a manual toothbrush or an electric toothbrush? Is it worth replacing a manual toothbrush with an electric one?

Marzena Dominiak
In general, a recommendation should always be made by a dentist and to this a dentist or dental hygienist or dental hygienist. We should come in and talk about the details, but if we compare the working efficiency or the shape of the working part of the electric brushes with a round head or the other brushes with a rectangular head, we see first of all their possibility of working quality in terms of fitting to the surface of the teeth. These are small and, by being small, we can move and adhere precisely. They can be to each tooth surface precisely, especially with the lower teeth, when we have a problem in placing this rectangular brush as we should place it in the arch, we sometimes have to turn it upside down in order for it to function well. With a small one like this, with a round head, we are precise. We can brush from all sides of these teeth quickly and effectively, because it only takes one and a half to two seconds that we apply to each tooth surface, including the chewing surface. In addition, we have colour lifters here that are able to show us the amount of pressure, which means they are safe for our gums.

Monika Rachtan
So electric toothbrushes are safe for our gums and can be gentle?

Marzena Dominiak
Yes, they can be gentle. We can see that with all sorts of tests that are available, or even with this kind of soap bubble that we are able to apply this brush and this bubble doesn't burst. But we also have this colour indicator where we are able to. I'm going to try to incorporate for a moment. If we press the pressure, it should be green. It should not be red as it is at the moment. And if we can we pay attention to that, because you can see it. We can brush our teeth in the safest way possible. We're not going to cause damage to the gums and that's kind of the most important thing for us in our whole procedure and we can confidently use them in different situations whether it's with braces or with surgical treatment as well. So as much as possible this recommendation is good and the right way of brushing should be discussed just in the dental office, so we are best able to pay attention to these details.

Monika Rachtan
Professor, and it happens that a patient comes to the dentist's office, to the professor's office, and he brings this toothbrush of his whether electric or manual that he has. And he asks the professor, am I brushing these teeth properly and is it even acceptable to do something like that? Is it acceptable for me to come with my toothbrush to the dentist's office and for me to be educated, so to speak, in the heat of the moment?

Marzena Dominiak
Yes, as much as possible. We invite you and we are even very happy that these patients want to come to us or we even ask patients to bring their brushes, because they show us almost everything. Show me the brush and I'll tell you how you brush your teeth. Because in fact, these heads are flattened, they're dishevelled, they cause the bristles to stop being flexible, hard.

Monika Rachtan
And here comes the answer to the question of whether to replace the tip of an electric toothbrush or whether to replace a manual toothbrush. Well, that's exactly what it is.

Marzena Dominiak
It is necessary to change the bristles once every three months because, first of all, the bristles lose their elasticity and resilience, the rounded tips are no longer rounded and can cause micro-traumas, such small wounds can appear. In addition, bacterial plaque can accumulate. It will nevertheless become more and more, more and more over time, which can additionally cause the induction of such inflammation, So this is why it should be replaced every 3 months, no matter what it is. We even sometimes say that if it's after an inflammatory or viral condition, maybe we should replace it even sooner.

Monika Rachtan
That is, after a cold, for example, it is worth considering replacing the tip.

Marzena Dominiak
Often it causes either a virus or a bacterium and they can unfortunately remain here and such changes can simply be sustained, so as much as possible it is necessary to change this and pay attention to it on a regular basis, as this will only prevent problems from occurring.

Monika Rachtan
Madam Professor. Those coloured hairs on the head of the toothbrush. Do they mean anything?

Marzena Dominiak
Yes, this change of colour from blue to white, for example, or from green to yellow, will tell us that this brush is worn out. So it helps us to have an extra lift, a colourful one in that it should already be changed. And let's pay attention to that, because it is indeed needed.

Monika Rachtan
And how do you store your toothbrush? Do I remember when I used to go to the camps and I was still using a manual toothbrush then, I had this plastic box. That's where my mum used to hide my toothbrush and it somehow always disgusted me with that box, because it seemed to me that I was just putting it in there and in that box I was growing, multiplying bacteria, so does it matter how we store our toothbrush and how is it safest?

Marzena Dominiak
Well we should store. Rather than in resealable boxes. They are so-called transport boxes, which means that when we drive from place to place, they should be closed in such packaging. In fact, so that it does not get contaminated by such external factors. On the other hand, after washing, it should be cleaned, it should be rinsed. Thoroughly. It should be free of this toothpaste or this residue. That plaque that is there and she should be dried. It has to be dry, so we should not put it in any packaging. On the other hand, it is also important that we do not put it in some common cups for the whole family, because unfortunately there is bacterial contamination. Let us remember that bacteria cause tooth decay, bacteria also cause periodontal disease, and this is something that we can unfortunately pass on from an early age. Parents unfortunately to their children. And that can change that bacterial ecosystem. And of course sugars. The sugars change the type of bacteria that are coming into the mouth and that's harder for us to eliminate later on.

Monika Rachtan
And let's also remember about sugars, that it's not just sweets and sweetened drinks, but an apple eaten in the evening is not good for our oral health either. If fruit, then yes to 2:15 pm.

Marzena Dominiak
Well, preferably fruit in general. Of course they are not forbidden, but they should be with meals, not as snacks, because they can additionally still cause us to enter into more difficult problems some insulin. Changes in insulin levels, sugar a lot is fructose. There is a more difficult metabolic problem here, so generally fruit is very good, but certainly not in the evenings. Not soft ones, not ones with a lot of just this fructose, as this is also a sugar that will cause us to change, to acidify this oral environment. If they are sticky and on top of that they stay in the spaces, especially between the teeth. So these are acids, of course, and they predispose us to the development of caries. And there is another factor that I think I would like to emphasise here. Well, because not everyone has the same tendency to develop caries. We can say, of course, because they brush effectively, but there is also the very important vitamin D level. I wouldn't be myself if I didn't say that, because unfortunately we also have a pandemic deficiency of this vitamin D and it often causes changes in bone density, Because if bone density changes, so does the structure of the tooth It's 95% percent histologically similar to bone.

Marzena Dominiak
So if it changes here, why not here? Plus the acids we have in our mouth. Proper brushing causes these cavities to occur many times more often, so further symptoms in the mouth we can pay attention to this. Whether someone has normal vitamin D levels or not.

Monika Rachtan
2,500 visits throughout Poland to be organised as part of the Poland Speaks A campaign, and I emphasise free visits. Professor, on the website of the Polish Dental Society, can we find precise information on where we can go, where these visits are made?

Marzena Dominiak
Yes, of course. We always have an additional website every year. Poland says, and not just on the website of the Polish Dental Association, so it's worth remembering. And there you can find precise information about the partner dentist's offices, which will provide these free check-ups. And you are very welcome, because it is worth taking advantage of it, it is worth talking to the hygienists, it is worth having this check-up of the oral cavity, because we can read a lot of things and change our habits, which I am very happy to invite you to.

Monika Rachtan
And I think I would like to tell you that the time has come when you should not be afraid of the dentist. And I think that these 2,500 visits made all over the country are a great opportunity to renew contact with the dentist. If someone has not been to this specialist for a long time, to see what modern dentistry looks like, that it is really pleasant and, above all, helps us to maintain the health of not only the oral cavity, but of our entire organism. Professor, thank you very much for our conversation today. Thank you very much. My guest, but above all your guest, was Professor Marzena Dominiak. This was the programme Po Pierwsze Pacjent (First Patient). My name is Monika Rachtan and I invite you to visit my social media. See you there.