Secrets of proper oral hygiene. Episode 52

Monika Rachtan
Hi Monika Rachtan. I would like to welcome you very warmly to the next episode of the "Po Pierwsze Pacjent" programme. Have you ever wondered what the most common disease in the world is? It is tooth decay. I will talk to Professor Marzena Dominiak about dental caries and proper oral hygiene. Welcome, Professor.

Marzena Dominiak
Good morning, and a very warm welcome.

Monika Rachtan
Thank you for accepting the invitation to join our programme. Today, we are going to talk about oral health in such a holistic way, because our oral cavity is a kind of mirror of our whole organism. Can we say that?

Marzena Dominiak
Yes, of course. This is a very good term. It comes up not only in our kind of jargon conversations, but it's one of the things that resonated at the World Dental Federation. What is happening actually shows us what the state of our body is. It just needs to be read skillfully. You have to understand and know what is going on. Simply looking at obviously we have tooth decay, then we can say we are eating too much sugary foods. Well, of course. Brushing, on the other hand, brushing is secondary, the ability to remove that plaque And that's very important, but for some reason it's done, which is the acidic environment, which is not only what we eat, but how we eat, so when we eat. So there is the whole question of dietetics and the possibility of doing the right thing and eating an apple as the last meal, which is not good at all, and often patients do not know that it is not just sugar, but later acids that remain in the oral environment. And I would also add fructose, which is not necessarily a good sugar for our body, because it is practically not digested. And this, in turn, is a problem in our intestines, and it's all interconnected, so there's really a lot to talk about.

Monika Rachtan
When a patient sits down in the chair and you look into their mouth, because I guess that's what I can say about it, or at least I think that's how our viewers think about it. By taking a look at just the state of the teeth, at what the gums look like, can you, Professor, conclude that there is something wrong with this patient's body? That it is worthwhile, in addition to going to the dentist, to see some other specialist.

Marzena Dominiak
Yes, we are able to say that for sure. There are many such symptoms. One of them we can say, for example, malocclusion. Why do we have so many malocclusions? I don't know if we're wondering that because there is? Before, there were no orthodontists and it wasn't so bad.

Monika Rachtan
And now every second person on the street walks around with braces on their teeth.

Marzena Dominiak
Exactly. The question is why? Among other things, we have found in genetic studies, not only in such clinical studies, observational clinical studies that are done, that there is a narrowing of the jaw in the setting of a lack of vitamin D, and if there is a narrowed jaw, that is, one that is too small in relation to the mandible, there are often bruises, there are often problems of various crossbites, abnormal occlusion of the temporomandibular joints at that time, gingival recession. This is such a correlation. Well, it is as I say, confirmed by research, that if there is a lack of vitamin D, we have jaw constriction.

Monika Rachtan
Well, but it is probably the majority of Poles who are vitamin D deficient, if we did such a population-based study, when is this supplementation so important for oral health, for healthy occlusion, is this supplementation in infancy, childhood or teenage years? Can these deficiencies also arise in 30 to 40 year olds? If these deficiencies are present.

Marzena Dominiak
They are related to the development of the entire maxillofacial system. As we can say, the whole organism develops. So in the prenatal period, that is, already pregnant women and even women planning pregnancy should already have the right level of vitamin D. Of course, during the developmental period in children who are growing, who are developing this orofacial system, it is very important that this vitamin D is not only this short period of time, when we usually have a few months immediately after birth, but, for example, the fusion of cranial sutures, bone sutures occurs around the age of 12, and if this level is then inappropriate, there is too rapid a growth of these bone sutures. This is why there is a narrowing of the jaw, which is then characterised by such underdevelopment. Misaligned teeth often appear, we have a lot of gingival recession. And now the sitting patient. When we see this malocclusion, we already know that there is something going on there. It is the same with periodontal disease. Here, too, there are direct accounts of the development of periodontal disease from vitamin D3 deficiency. And vitamin D3 is a major contributor to the production of mesenchymal cells and this will affect the immune system. So again, we're moving in that direction, which is to say we can see that there's some obvious cause for what's actually happening. So at least by this relationship we are able to say that there is definitely something wrong.

Monika Rachtan
Does your professor start the conversation in the office with the patient by asking if these D3 deficiencies are present in the patient? Has he or she done any recent tests? Do you recommend such tests?

Marzena Dominiak
Yes, this is a very common question and often even patients laugh a little bit because they say, smile. That's what I would say. They don't laugh, they smile. We are at the dentist, we ask about vitamin D. Yes, we ask and we even test, because we have these simple devices in our offices that we are able to tell within 15 minutes, just by taking blood from the finger, what the level of this vitamin D3 is. And this is indeed important, because it not only tells us that there is this problem and confirms our diagnosis, but on the other hand it affects the possibility of proper treatment, because in the absence of vitamin D we have, for example, dry alveoli, more often after tooth extraction. Patients often say I tend to have dry alveoli, it's not that tendency. This is often investigated with just this deficiency of this vitamin D3. Periodontal disease is also not cured by any means. If someone will have a vitamin D3 level of 4, 7, even 14.

Monika Rachtan
And these levels do happen don't they?

Marzena Dominiak
These, unfortunately, are very common.

Monika Rachtan
This standard is probably around 30, if I remember correctly.

Marzena Dominiak
From 30 to 100, and we cannot have this lower standard, because it means that we are really deficient, and vitamin D3 has a pleiotropic effect, it acts on more than 30 different organs and tissues, and if it is 30, it will barely reach those 30. So we actually have to have this level, as confirmed by the American Endocrine Society, among others. On soft tissues, for it to have a positive effect, there has to be a level between 40 and 60. So we have to know that this level has to be higher. If we are talking about bones, we are even talking about higher levels. We should have levels of 60, 70, 80. Of course, monitored levels, you can't just take vitamin D and not know what's going on, because that's when it brings some problems, because too much, of course, you can develop lithiasis, you can develop all sorts of other systemic problems, so we have to have it in the right framework. We have to keep in mind the different cofactors, we have to correlate with the whole organism. And it has to be tested, especially in the beginning the level every three months to stabilise that level, just like other hormones.

Marzena Dominiak
It has to be compatible, because it correlates with blood sugar levels, with insulin levels, with levels, among other things. I wanted to say some other hormones escaped me at the moment, but the thyroid, that's what I wanted to say about the thyroid. Secondary hyperthyroidism can develop from this. By the way, parathormone goes up, vitamin D3 goes down, so it's really very important what these interrelationships are. Here there are still some kind of influences with the so-called glutathione deficiencies, that is, these oxidation enzymes. There are some very good papers written about which these relationships are, so it is important how much and how. That is, we do not go to the pharmacy and buy a single tablet that we swallow, because it apparently only gives us the assurance that we have this vitamin D3. You need to consult your doctor and figure out the right levels and supplementation.

Monika Rachtan
We are going to talk a lot today about oral hygiene and how it too should be dedicated, matched to what is going on in our lives. But it is the same with vitamin D3. And here and here you need a specialist, you need advice, you need a check-up, so don't do it on your own. Just remember that wonderful GP dentists are here to advise you. I would like to come back to oral diseases. Caries, periodontal disease, malocclusion. How do all these conditions affect the condition of our whole body? For example, can such a development of caries cause us any ailments outside the oral cavity?

Marzena Dominiak
Yes, these are things that are very much interrelated. I will just give a few examples, because you could talk about a lot of them, because caries or periodontal disease are bacteria, they are bacterial diseases, so they can be transmitted from person to person, so for example, it is wrong to brush with the same brush at home or to have the same brush in the same cup.

Monika Rachtan
That is, we should have separate cups. Ideally, we should have two different colours we know which are whose and not mix.

Marzena Dominiak
Exactly the same after an illness. If we are either after treatment for some periodontal disease this brush should be if not replaced then at least disinfected. There are different ones that we can at least disinfect in microwave ovens. These are available.

Monika Rachtan
So it is very simple.

Marzena Dominiak
Very simple. We no longer have to throw away more and produce the number of these toothbrushes that we throw away into the environment, but we can prepare them properly and disinfect them. This is very important, because like a bacterial disease, well we carry bacteria. So it's important that we remember that. So the mouth is the initial part of the digestive tract. What we have in the mouth, we swallow and this digestive tract. In the other direction, the oral cavity is also affected and we will not cure all sorts of gastrointestinal disorders. If the oral cavity is out of order. Someone has advanced periodontal disease? There is no way to achieve a properly functioning bacterial ecosystem in the gut. The other side of periodontal disease correlates with diseases such as Alzheimer's. There is even a so-called 'Polish Nobel Prize' that was awarded at the University of Medicine in Wrocław, Wrocław General University. For Professor Potempa, among others, indicating that such correlations exist. So what we are seeing here is an illness with a psychiatric basis. We have been saying the same thing for many years about cardiology, which occurs. The same occurs with diabetes, diseases, pulmonological diseases that will occur, but in the other direction.

Marzena Dominiak
If, for example, we find that there is very advanced caries, I have already said that it is an incorrect diet. There is too much sugar, but this sugar is also glucose and fructose, so if we consume too much of this, it can help to show the corresponding symptoms, the corresponding remodelling and formation of fatty tissue, in fact we should say and around visceral organs such as the liver or within the alveolar bone. It is very simple to see this on the basis of the CT scan that we perform and then we speak, for example, of bone marrow steatosis. This was previously the domain of orthopaedists, because most often orthopaedists took pictures of the spine and there are diseases defined modic 1, 2, 3, 4. But we found that in dentistry.

Monika Rachtan
Well, yes, you do take these X-rays and CT scans.

Marzena Dominiak
It is the tomography. And on this tomography we can see and it is becoming more and more a routine imaging modality. We're talking about what's called 3D, this kind of three-dimensional imaging, and most dentists do because it's an accurate picture that shows us what's going on both in the teeth, and the alveolar ridge, and the maxillary sinuses. And it's popular enough that we can also assess that bone density and see that these things are happening. So it's such a simple indicator. We can see that something is happening. OK, we still have too much caries. We link this to the fact that perhaps the patient, for example, is eating too much, for example, just snacks or fruit, because there may be, I'm not talking about just eating sweets, but just apples eaten every day as snacks or or most fruit, and it turns out that it's not going to be good at the moment, they will be good after the main meals when we include them together. However, as snacks or we replace one of such meals that we should actually eat with some protein and fat products, it turns out that she can directly appear and transform into just this fat tissue.

Monika Rachtan
I wonder. You are a very active professor when it comes to dentistry in Poland. You are the president of the Polish Dental Association and the knowledge you present is, in my opinion, rather unparalleled among specialists. We were talking even before our recording that you are interested in this holistic approach to a healthy organism, and I wonder whether the dentists who practice in Poland, practise most often in private practices, of course, because I personally don't know a person who has used a dentist at the National Health Fund and I don't know where I could get such advice. It has happened in our country that the commercial market has developed more. On the other hand, I wanted to ask whether such conversations as we are having here now are standard in dental practices, or whether, however, most specialists focus only on the teeth and what they see in a CT scan image, they don't really look at it in such a holistic way. And the second question from my audience straight away how do I find a dentist who is willing to talk to me about the holistic health of my body and also my mouth?

Marzena Dominiak
This is a very interesting question and I thank you very much for it. I think it is analogous to what is happening generally in our health service, in general medicine, because we have a very divided market into specialists in particular areas and often specialists in different areas deal with a particular type of treatment, for example, we have, I don't know, orthodontists, well an orthodontist assesses certain things, or we have orthopaedists there as well, well we can compare that. In the same way we have endodontists later on and mostly patients come for specific treatments. In the same way as there are few internists at the moment who will approach this holistically, there will be few dentists who also approach holistic treatment in such a way, holistically. Mostly, I have to say, this applies to surgeons who are dealing with procedures that are performed, quite irreversible. Because if, for example, we're talking about placing implants, if we graft them and they don't take or they don't take after a while, then we have a problem. And we have to deal with it. So in order for us to know and prevent the occurrence of this also very common disease, even the disease is a symptom, Periimplantitis then we have to skilfully assess many parameters. That is, we start talking to the patient at least about this vitamin D.

Marzena Dominiak
I think that for more than 10 years now, we have been talking about this at many conferences and lectures, and most dentists already know that this is necessary. We are starting to show it more and more often and now we are organising such a conference in a few days' time, at the beginning of June, in Wrocław, the Wrocław Implantology Days, where we are going to talk about such biotechnological evaluation of the possibility of evaluating blood morphology, so that we can see whether there are predictors of acute and chronic inflammation there. So this is our teaching from the point of view of the Polish Dental Society, because the organiser is the Polish Dental Society. We try to show postgraduate education, because we are talking about postgraduate education. With diplomas, of course, such information appears. I even had a lecture just a few days ago and we show this coverage. Whereas it's not like it's a standard regulated curriculum, which has certain limits that we are able to do, because it has to be approved by the ministry. So we are moving towards postgraduate education. In this postgraduate education, we organise legitimate or training courses or masterships like this, which give us the opportunity to develop this knowledge, so we educate the next generation to be able to help our patients and detect these kinds of abnormalities.

Monika Rachtan
From these difficult topics and complicated mechanisms that you mentioned, Professor, I would like to go back to our homes, to our bathrooms, to our sinks, to our toothbrushes, toothpaste and all the things that we should, I hope, use every day, but we are taught to brush our teeth from childhood. We get our toothbrush even before that, our mum brushes those teeth for us when we are a baby. Then we learn to brush them. And we often end up brushing our teeth. A preventive visit to the dentist once a year. If something needs to be done, we do it. However, we brush our teeth in the morning and in the evening and we think that everything is ok, that we have already done everything we could have done for oral hygiene. Is that enough?

Marzena Dominiak
Practically not enough. It's nice that we already know that we need to brush our teeth, but whether we brush twice doesn't tell us the statistics either. Most often we brush once a day. This is where the statistics come in, unfortunately. We also don't know how much we brush, because we often talk about how long, how short, how much we say two minutes, we should brush. These two minutes seem very long. We're helped by all sorts of even information on the display, on all sorts of electric toothbrushes, broadly speaking, which we can already see the individual even areas where the quadrants whether they're actually brushed or not, or the applications that are going to come up, they're very helpful. So if we have some kind of problem here, well we are able to moderate that. So this is not correct. And twice a year we should go to the dentist, we don't usually do that either, because we shouldn't come when something already hurts, because it's already too late. We should only actually use this prophylaxis to anticipate the appearance of certain undesirable effects. And I can say one positive thing, maybe not one, but such a positive thing in the case of the National Health Fund, because the treatment of children is reimbursed practically from birth to 18 years of age, at the moment in its entirety, and this communication is often not there, that even people or parents immediately after birth can come to the dentist and learn about this first hygiene, because they often simply do not know what to do. Are they supposed to even think about some brushing there, because that would seem to be what exactly. Do they swallow? Not to swallow? Fluoride How much of it do we have? What should it look like? Because it's very important that up to the age of 12 the parent should certainly accompany the child through the brushing of the teeth and let the toothbrush be used, of course, at the beginning, let the child brush, but the child only searches for the teeth in the front section, it won't think about those deciduous molars or even in the first permanent molars, which will erupt at the age of six-seven more and more often earlier and earlier now. So the parent has to complete proper brushing. He or she has to create this habit in the child, otherwise why does decay appear so often in the sixth molars? Well, because they are the ones that are under-brushed. And again, it's not because someone doesn't clean, because they'll say I clean twice a day after all, but just inaccurately, not with this method, they don't know exactly how to do it.

Marzena Dominiak
And it is indeed important that one should choose a different paste in the morning and in the evening. Maybe someone has sensitivity, so it should be used for sensitivity, but on the other hand helping to remove plaque. If someone has periodontal disease it can also be different. Well, because if there is periodontal disease it doesn't mean that he can't have clean and white teeth, so it can be whitening in the morning and in the evening with antiseptics. Chlorhexidine or Fluorinol is another remedy. One is more against decay, the other is antiseptic, so we can select these toothpastes, so not one paste for everything, so that we don't think about it, but we have such a portfolio of these different plaque-removing chemicals and not only toothpastes but rinses as well are selected depending on what is causing the disease. We have gels that increase the concentration of, for example, chlorhexidine topically, especially the spaces between the teeth, because we forget about that.

Monika Rachtan
Professor, how do you know which product to choose? Because I am deeply convinced that Poles first of all buy these hygiene products in drugstores, more in beauty shops or simply in supermarkets, and there is no one there to ask what kind of toothpaste I should choose? For example, should I use a special gel after having my eights removed? Who is the best person to get this information from? Who can I turn to? Who do I talk to about it?

Marzena Dominiak
I think dental practices are dedicated. Of course the doctor, the dentist, but also the hygienists, the hygienists. This is a professional group that should and does spend a lot of time and has a very broad knowledge of oral hygiene and we should then choose the right measures. Oh yes, we can say as I said that some can for hypersensitivity, others for caries, others can be after treatments. Different, not only the active ingredients that come in, but also their concentration, because at the beginning we can use concentrations that are higher and then we can use concentrations that are lower. It is not necessarily then chlorhexidine alone. She is often another active agent that appears for chronic use. It is the same with the choice of brush. There are soft post-operative brushes, that is, patients often ask if they brush their teeth at all after procedures, well yes, I can't imagine three not brushing their teeth. And after the procedure there is an open wound. It's like a wound on the skin. If there is a wound we disinfect it. So why can't we disinfect it in the mouth?

Marzena Dominiak
This is as necessary as ever. Let us not be afraid of this. It also needs to be cleaned, the doctor also cleans the skin, for example, after a fall, and this skin also needs to be cleaned here. There is one more thing I would like to say about dental plaque, because patients often don't know this, they don't ask because they say, well, I had calculus removed a few days ago, I have calculus again, when the patient comes before the procedure. Yes, because after 12 hours the plaque is already deposited after the teeth have been cleaned, and after 48 hours it is already mineralised, it forms tartar. So it is not forever that I have removed the tartar and it is only necessary to carry out this hygiene properly twice a day.

Monika Rachtan
Patients are also afraid. They postpone their visit to the dentist very often because they are afraid of the pain, especially with the removal of the eights. I think this is a procedure that is pushed back in the minds of patients, young people, often as far as possible, because everyone knows that after having the eights out there will be swelling, you will have to take time off work, it will hurt terribly, the procedure is unpleasant. And can it be nice and pleasant after the removal of the eights? If we incorporate proper hygiene, proper care, if we take proper care of the very wound that is created in our mouth, is it possible that we will go through this procedure with a smile?

Marzena Dominiak
Yes, this is of course the stage immediately after the procedure and it is obligatory. And it is the dentist's role to tell the patient what to do, he should even write, because the patient is often so stressed after the procedure that he will not remember, so there should be printed information on what to rinse, how often to rinse, how to brush the teeth, when these post-operative brushes, post-operative gels, post-operative liquids, toothpastes are properly selected. They often have either anaesthetics in them or appropriate preparations of chlorhexidine, for example, which will have an antiseptic effect. We want, for example, a higher concentration, then we can use a gel. So this has to be said by the doctor and it is as important as the use of, for example, an antibiotic, and sometimes even more important, because we know that now we are in the post-antibiotic era, so the use of antibiotic therapy in the extraction of eights is practically contraindicated and in most cases, if they are partially retained, we should not use such prophylaxis. And it is also important to create awareness in patients that there does not have to be an equal sign. Well, after all, I have an eighth, then I need an antibiotic, and often patients require this.

Marzena Dominiak
On the other hand, it is not needed, because in many cases it is not needed, and post-surgical antisepsis replaces precisely this systemic treatment, so we can feel better, healthier. If the treatment is done properly this is very important. There will be prior supplementation of, for example, vitamin D or the right level. And this prophylaxis, this chemical plaque control. We call it nicely. There will be proper and appropriate instruction. This is the basis for everything to go well.

Monika Rachtan
We push back the pulling out of the eights, and if it turns out that we have four to pull out, we don't want to relive this terrible situation four times. Is it possible to get four eights out in one day?

Marzena Dominiak
Let me put it this way, everything can be done. There are procedures under general anaesthesia, which are carried out, for example, extraction of four eights. And now everything depends on how these eights are retained, what the procedure looks like, what the procedure time is, because this is also important, what the procedure time is. Yes, there will be possible postoperative complications, because we have to know that a haematoma can form, a long swelling, a big swelling can form. If there is going to be a prolonged procedure, over 2 hours, this in itself generates large complications. We even say that if the procedure lasts more than half an hour, it will already generate complications related to a large reaction on the alveolar bone. These are such simple mechanisms at the cellular level of processes that are released, enzymes respectively that will slow down. And the longer the treatment lasts, the more likely it is that at least these dry alveoli will form. Why can I say this, so that you can believe that this is the case. After ones when we remove or twos or threes we most often do not have dry alveoli and after eights, because they last longer.

Marzena Dominiak
So that time is important as it is. And it doesn't mean that now we have to do everything as fast, as quick as possible, but to plan it in such a way that if we see that there are very difficult these teeth, then maybe let's not go in four eights, but on one side e.g. on the right or left side the top with the bottom and divide it into two e.g. on the right or left side. So it's then better tolerable. The patient can eat with the other side, it all heals better. So it has to be selected by the doctor. And everything is possible, because at the moment we have such possibilities, such technology, that we can really do practically any kind of treatment, it just has to be all for people.

Monika Rachtan
Well, the technology of possibilities. If you were to compare the dentistry that was 10 15 years ago to the dentistry that you see today in the dentists' offices, probably also in the office where you receive the professor, what words were said.

Marzena Dominiak
There is a dentistry that is completely different. It's modern dentistry, we can say no longer of the future, of the present, when we have digital imaging, dental surgery, because we can do personalised bone reconstruction, we can do templates in which we are able to place implants just as the image on the computer on the computer screen dictates to us. So these are the kind of navigations we have, the static navigation, the one we talked about, but we also have a dynamic one, which is a little bit of dental work, we can tell ourselves a little bit smaller, but under the control of the computer, the image on the computer we are able to do these procedures in the right place, going back or removing foreign bodies, tooth roots, different cysts that occur. So there is that, microscopes, we have scanners. It is a completely different picture of dentistry.

Monika Rachtan
And does this technology and these modern treatment methods translate into the fact that once these teeth are done, as they say in Poland, you have them for a little longer.

Marzena Dominiak
If we don't take care of them, there is nothing for life. It's not that if we have implants, nothing will happen anymore, because with implants we will develop, well maybe not caries, but we will develop periodontal disease. If we don't clean our teeth properly, because periodontal disease, of course, we were talking earlier about the immune system and abnormal function. So that's one of the causes of these advanced periodontal diseases, but they can also develop gingivitis and then periodontitis purely because of improper cleaning of the plaque that follows, the calculus that will build up. And these may not be as violent, but will nevertheless cause bone loss recession in the interdental spaces. Because of this, the implants become exposed. We start to see something grey, which the patient doesn't like. So it's not that we are exempt from proper oral hygiene and care and checks with the dentists. If we do crowns on our teeth, if we do implants. However, this is our body and it's all connected and that plaque on the teeth will still build up. Those bacteria won't stop, they have a different adhesion. Of course.

Monika Rachtan
And to encourage our viewers to visit the dentist, I would still ask if modern dentistry hurts like dental treatment? You have to admit, it did hurt 20 years ago.

Marzena Dominiak
Of course, we have fantastic anaesthetics, there are fantastic, good agents, but there are also good devices with which we can deposit these anaesthetics. They can be done under what is called oncotic pressure, which is the pressure that will cause it to be absorbed immediately into the bone tissue. That is, what hurts is the rapid administration, the stratification of these tissues, i.e. a kind of balloon is made. Probably everybody will be more or less aware that these things are done. And if you administer slowly, which is pretty much how the timer works, then they get absorbed straight away and you don't have those kind of complications that will, will form and it really doesn't hurt then. And you can do the most sublime surgical procedures like that, giving even one ampoule of it just the right way. So there are such possibilities that we can do these procedures in a virtually painless way. And this should be sought out. There are, there are surgeries that are dedicated to this, there are campaigns that we announce in the Polish Dental Society. There are surgeries without pain, various depending on what the action is called, we talk about them.

Marzena Dominiak
You can find a lot of stuff on the 'Poland says aaa' website. This is the kind of website we have, of which it still exists. Still. Why? Because it's mostly dedicated to World Oral Health Day, which is on the twentieth of March, But all year round this website is there, so you can see www.polskamowiaaa and there's all this helpful information you can find. How, what, where, what are the partner surgeries, where you can register for check-ups, sometimes free different kinds of actions appear in schools, kindergartens, not only also in partner surgeries of our various partners of the Polish Dental Association. So I encourage you very much to do that, because we can really take a bit of a breather.

Monika Rachtan
It is clear from our conversation that this proper oral hygiene is key here. Of course, what we eat, what we supplement, is very important, but nevertheless brushing our teeth properly and taking care of this hygiene is key.

Marzena Dominiak
It's like washing your hands. If we don't use our hands, well, we know what we can get ourselves. We had covid recently and saw what happens. It is the same with the mouth. If we don't wash it properly, all sorts of diseases will be induced, because there can also be cavities of non-carious origin, which are, for example, from acids, all sorts of erosion. But they can also be from improper excessive brushing, because this is still to be said, because sometimes patients say okay, I'm going to scrub hard and this kind of puceritis is also not good, because there will be such indentations, we say wedge-shaped cavities. So there has to be a proper brushing technique. And this is what the dental surgeries have to tell you how to do. And you need these measures, I just wanted to say dental surgeries. We go to the pharmacy, in the pharmacy the pharmacists know what to advise us. You should have these pharmaceuticals and these means of chemical plaque control preferably just tested in this way, because it is just certain what we are doing and what we are using.

Monika Rachtan
If we were to sum up for our viewers what that ideal bathroom cabinet of ours should look like, with all those oral hygiene products standing in it. And let's say that we are not currently affected by any surgical procedure. We don't have periodontal disease, but nevertheless want to take responsible, professional care of our oral health. What should stand in this cabinet.

Marzena Dominiak
Of course, the toothpaste that should be against caries in general, that is, for example, the fluorinol of the content that may be inside, or some preparation of fluoride that will adequately supplement. We can also say, they will supplement those deficiencies that arise on a daily basis with an antiplatelet, one that is in the way. Then there must be, there should be a rinse, but it must not be with such a high chlorhexidine content or a low one or with other preparations that appear that cause a better prophylactic effect as far as the removal of plaque is concerned. That is, we do not go for the strongest preparations, but those for everyday use. What is important, they are usually prepared in appropriate dilutions, i.e. not such concentrated preparations. We should have toothbrushes to remove plaque from between the teeth. Very important are the microbrushes with which we have to brush, because we forget about these spaces between teeth. They are extremely important. This is again linked to diet, because we do not eat hard foods and they do not clean these spaces, so that is why. Another element is the tongue brushes that we have to use, because there are over 60% of bacteria on the tongue, which are present throughout the mouth between the filiform papillae on the tongue.

Marzena Dominiak
So toothpaste, mouthwash, a traditional toothbrush for brushing teeth, an interdental brush that will come in this way. There may still be gels depending on what the situation is, especially with orthodontic treatment. With such additional situations that are needed, they must then be dedicated, although also for daily hygiene. They can be used especially, for example, on interdental brushes, when there is some major care for a space there.

Monika Rachtan
It's the holiday season, it's a beautiful May and probably most of us are going on holiday, will be travelling somewhere. Some will fly by plane, others will go by car and there's always the problem of how to pack that make-up bag. There seems to be a lot of all these things. And now we have mouthwash, we have special brushes for cleaning the spaces between the teeth, we have a soft toothbrush for applying gel, a medium-hard one for brushing the teeth, every day, two toothpastes. Is it possible to indulge on holiday and only take one toothpaste.

Marzena Dominiak
On holiday it's the kind of time that we can indulge ourselves, because it's clear that we don't need to overdo it and we don't need to have such a big make-up bag. 24 by 24. If there's going to be one paste and one brush and the right method of brushing, it's already very good. Coming home, well, we're back to other habits that come up. What can we do on holiday? There might even be salt water, there might even be a pop of ordinary water, but quite intense, that might come up. But this salt water is such a good solution if we want to get antiseptic. The oldest method. Sometimes we can manage in this way.

Monika Rachtan
And after the holidays, we return to good habits. We reach for professional products, and of course we buy them at the pharmacy. Professor, this programme is primarily dedicated to online viewers and I sometimes on some episodes allow myself to collect such questions on the internet from just our viewers and here to discuss with the expert who sits opposite me. I only have three. Can I?

Marzena Dominiak
Of course.

Monika Rachtan
Many times people write that they do not look at their child's oral health when they are at this younger age. Well, because it's the millipedes and so the permanent ones are only going to fall out, we're going to take care. And the millipedes there any hole, it's nothing. Is this a good approach?

Marzena Dominiak
Absolutely not a good approach. Millipedes are teeth too. They dedicate, yet in general the decay of these milk teeth also hurts. So it is not that our child does not hurt. If such cavities appear, an adult hurts and usually runs quickly to the dentist, while a child often cannot even tell that it hurts well, yet cries, does not want to eat, does not function properly, so it hurts. The poor diet that ensues, Well, because the child simply won't eat, won't drink, won't function. This in turn translates into the digestive tract. As we have already said, tooth decay is bacteria. We ingest these bacteria, so we further shape an abnormal ecosystem in the digestive tract. In addition to this, the inflammatory changes that develop around the teeth are the ones that can affect the condition of the permanent teeth. It's not insignificant that an abscess will form there, that a cyst will form there, because it's just not there, because it affects the follicle of that tooth erupting underneath. Also, as we lose teeth quickly, we don't have that signpost for those teeth with the correct performance of those teeth.

Marzena Dominiak
They shift, they produce just these dental defects, malocclusion, and not to mention the aesthetic problem, because I would like to mention, there are these studies done in 2016-20 by, among others, the Ministry of Health commissioned, in which we say that children at the age of 12 have between 7 and 8 percent, they are afraid to smile because of their teeth. So it really is frightening. Young children don't want to smile anymore. So that also has a huge impact. Social acceptance, a nice white smile and we definitely perceive such a person better than one who has problems. Black teeth, because one of the possibilities, of course, is not black, because there is decay, but black are the methods of, for example, such a lapis of teeth, if there is no possibility of treatment, but there is once the possibility of making these children's smiles white again. Also, how do you explain to such a young child that he has to sit in the chair and let himself for an hour, let the filling be done? Then we reach for what, general anaesthesia, and we know that general anaesthesia is medication also affects health. We can't repeat them too often, because even a healthy adult body can take general anaesthesia every six months. So in children all the more so with general anaesthesia. So again, there are special methods. Often there has to be intubation through the nose, because when we treat the oral cavity, we have to know that we can't have that endotracheal tube through the mouth. So that makes, of course, again everything we can.

Monika Rachtan
Just what for? Better to take care of prevention.

Marzena Dominiak
Exactly right.

Monika Rachtan
And not to have such problems, not to stress the child, because for the child it is a huge stress, such a procedure. So here this prevention, hygiene is extremely important. Second question: manual or electric, sonic? Which toothbrush should I choose?

Marzena Dominiak
One that will give us the opportunity to clean, any we can do. With a manual one we can also clean our teeth properly and here there are no contraindications not to do it. And electric brushes as well. And the choice of these brushes depends on what we want to achieve, because one and the other whether electric or sonic have slightly different brushing mechanisms. One sweeps more, the other sweeps more through the surfaces between the teeth. And they are important. At the moment, there are some that we don't use. The movements, because they vibrate on their own and we just have to move, so with each one we have to know how to do it.

Monika Rachtan
So again, I guess you have to go back to the dentists and individually select this solution.

Marzena Dominiak
If we buy in a shop and don't know how to clean, we will have the same problem as with a manual brush. Skillful brushing with one, two or three has very good results, but it is necessary to see a dentist to tell you this or a hygienist, a dental hygienist, to properly teach you how to do it.

Monika Rachtan
If it is my dental appointments that have been frequent recently, periodontal disease is actually occurring, tooth decay is appearing, should I discuss this with my primary care physician? Should I inform him/her that I have such problems? Could this be relevant information for the GP?

Marzena Dominiak
I think this is very important information, because it can be due to a general health condition, even if it is diabetes. But this information, this awareness about this should be built up between dentists and GPs. And this is the project we have at the moment with the Polish Dental Association. We are just starting activities and meetings. We have a meeting next Monday of such a round table, which we will talk about. How this communication, post-graduate education should look like in terms of dentists and doctors, in terms of primary health care, so that we know both what to pay attention to, what is key. On the other hand, it is of huge importance, because I gave the first diabetes, with diabetes we know that everything heals worse. I know that there can be more frequent problems with tooth decay, periodontal disease. Therefore, if this is the case, then perhaps this sugar level needs to be checked after all, because maybe something is not quite right or has become unregulated, because this can also be the case.

Monika Rachtan
That is, this control is extremely important. We should not only control our oral health, but also many other parameters, including vitamin D3 levels. I don't think I need to convince you any more after talking to the Professor that it is worth reaching for professional products that are dedicated to oral hygiene. And you can get these products mainly in pharmacies. I visited such a pharmacy at the beginning of the episode, so this is where I invite you to today, thanking you for your attention. This was the programme "Po Pierwsze Pacjent", my guest, Professor Marzena Dominiak Thank you very much, Professor, and my name is Monika Rachtan and I thank you for your attention.