Functional dentistry: what do teeth say about all health? Episode 104

Monika Rachtan
So you mean to tell me that Poles do not brush their teeth every day?

Emma Kivorkova
Yes. More than 90% children between the ages of 6 and 12-13 require immediate dental treatment. We don't come to the dentist to have our teeth taken care of, we come to the dentist to have the whole stomatognathic system taken care of. When was the last time you had your teeth done? This they had difficulty answering. It was not the obvious 'this morning'. Poles in general are afraid to go to the dentist all the time. What we were looking at in the periphery was a state of affairs where, for example, a 10-year-old had a dozen cavities each.

Monika Rachtan
Hi, Monika Rachtan. I would like to welcome you very warmly to the next episode of the programme "Firstly the Patient". It has so happened in Poland that dentistry is the field of medicine that has become the most privatised. Just like gynaecology. And this is also what I will be talking about today with Dr Emma Kiworkova, who is my guest. Hello very warmly, doctor. Doctor, are Poles afraid to go to the dentist at the National Health Service?

Emma Kivorkova
Poles in general are afraid to go to the dentist all the time. And this is the lack of awareness that we are trying to combat. And we dentists and also myself and my team within our foundation. But when it comes to the National Health Service treatment itself, I think it puts off many patients, the more aware ones. When I hear stories like this, for example, from parents who try to make an appointment for their child for treatment at the National Health Service and when they hear that the appointment is, in a good case, in a year's time, but in fact in two years' time, well, an informed parent realises that in two years' time, when they come in, there will be nothing left to come in with and such teeth will have to be extracted. Consequently, they give up consciously.

Monika Rachtan
Doctor. They give up in the sense that they need that moment to get to the point, though. No okay, I'm not going to wait two years, I'll go privately. For example. They come to the first appointment, they see how much it costs, because it's also in general facing this cost at the very beginning very difficult. And yet they take up the gauntlet and say okay, we're doing private. Do you have any examples of people who have waited too long, or of people who have waited too long at all, or not just children, but adults, or people who have heard at the National Health Service that they have to wait a long time or that they're not going to get something done, then they back out, go home and don't go to the dentist for, say, six months.

Emma Kivorkova
Madam Editor, well, everything you have said is absolutely true. Poland is statistically, in terms of world statistics. At the very bottom when it comes to the dental status of Poles, when it comes to the dental status of our children. We, as a foundation, did one of the largest surveys on a huge scale and it turned out that over 90% children aged 6 to 12-13 require immediate dental treatment. When it comes to the dental status and children, seniors too. We also had senior programmes where we looked at what the dental status was and created a map of Poland. Well, I used to come back sick after such trips, I was back for a few days, I had to recover a bit mentally, because what we deal with in private facilities, with what kind of patient, is a completely different reality. In the context of what we would see, for example, on the outskirts, somewhere in smaller towns, not to mention what happens in villages, for example, where we would come to a primary school for an examination and even such a simple question as asking a child "when was the last time you had your teeth?" That they had difficulty answering. It wasn't the obvious "This morning it was". They had to think about whether it was yesterday morning or last night. The state of awareness is tragic and however much we talk about it, it still won't be enough. The state of consciousness of parents is poor, so it is not surprising. Children primarily imitate what they see at home. If parents are afraid to go to the dentist, if parents don't take care of hygiene, the child will mostly reproduce the same patterns. A lot of time has to pass. He or she will grow up and if there is a child who is more open observing, absorbing, seeing, peeping at who is doing something different, something better Well, he or she has a chance to get out of such a pattern and also already take care of his or her children's dentition when they enter adulthood. So what we were looking at on the periphery was a state of affairs where, for example, a ten-year-old had several cavities, terrible oral hygiene, several teeth to be removed. Six-year-olds, who are just cutting their sixth, first permanent teeth, are not yet fully erupted, and already have cavities. Not to mention malocclusion and how much there is to do here. As far as adult patients are concerned, when they go to the National Health Service and hear that they are entitled to treatment from three to three, and beyond that, it is as if we were going back 100 years, so a lot, a lot still needs to change so that treatment at the National Health Service can compete with what private dentistry can offer, which is at a very high level in Poland. And here I want to emphasise, praise to our dentists, because this is really we can be with our heads held high walking around. This is a very high world level. Whereas the awareness of patients is at a very low level all the time, in big cities it is much better. That's why we live in such a bubble. We walk, we care, We care for our children, our children's children. We take care of our parents. We get them to the dentist. The further into the forest, the worse it gets.

Monika Rachtan
I will tell you from my own experience that I recently looked for a prosthodontist for an elderly person in my hometown of Zgorzelec, which is not a very backward town, but a border town in Lower Silesia. And can you guess, doctor, how many kilometres it is from Zgorzelec to the nearest NFZ prosthetician?

Emma Kivorkova
Well, I assume that far.

Monika Rachtan
The 100 closest was in Jelenia Góra. That was one place. The other was probably Legnica, and so many facilities in Wrocław. And now I was wondering how to convince retired seniors to go to a prosthodontist in Wrocław, where a visit to a prosthodontist is not a one-off procedure, because you have to come first. The prosthodontist has to diagnose everything, find out, take measurements, many visits. And I thought to myself, Jesus, I don't know, I just don't know how the Ministry of Health, the National Health Fund, says that prosthetic treatment is reimbursed one hundred per cent for seniors, that you can have it done for free, and here it turns out that, OK, you can have it done for free, but you have to spend a thousand zlotys on travel to be able to even think about having this prosthetic made well and within the National Health Fund. But the doctor said one very important thing, and that is that children do not see their parents make a habit of brushing their teeth twice a day. Some even brush more often. I happen to brush my teeth more often if I feel discomfort. So you mean to tell me that Poles do not brush their teeth every day?

Emma Kivorkova
Yes. What I am trying to say is that what seems to us to be the standard and the norm is not so standard at all, that if we did an anonymous survey, an anonymous poll, and asked Poles to answer honestly how often they brush their teeth and how often they visit the dentist, I think you would be surprised at what you would read.

Monika Rachtan
If you found our conversation interesting and are looking for more valuable content. Subscribe to us on YouTube and Spotify. Monika Rachtan. You are invited. The Polish Dental Association runs many information campaigns. Personally, having been to a NFZ-only dentist 100 years ago. I remember all those posters with that apple, with that white tooth, and sort of. Well, and how can you not have teeth every day when you see an advert for a toothbrush and toothpaste on TV every day? What is the reason for that?

Emma Kivorkova
Statistically, it is considered that if someone brushes their teeth once a day, they are already in a slightly better group. I'm talking about us as a foundation. I wouldn't believe it myself, because what I am saying is that the patients who come to my clinics are a completely different patient, a conscious patient who cares a lot. He comes in often asking the question that gee, An educated patient already. And that is great. On the other hand. On the other hand, the average in Poland is tragic. Badly, improperly, they don't care enough about hygiene. Not to mention the fact that nutrition is getting worse and worse, and this has an extremely big impact on how our teeth look later on. Children learn by watching and imitating what they see at home. So if parents don't do that systematically. And if I say, 'Oh Jesus! To the dentist is what the child hears, then it gets encoded all in the subconscious and then that child replicates exactly the same things. He doesn't think it's so important anymore to take care of hygiene in great detail and he doesn't take care of it in the right way.

Monika Rachtan
And is it that this dentistry that is being done within the private sector. I have many friends who are now. They are getting their teeth done because they are those children whose parents didn't take proper care of their hygiene, or simply couldn't afford it, or weren't aware of malocclusion, for example. What the doctor said and it turns out that there are no cavities, but the bite is not correct. You need orthodontic treatment. God, at 40 you have to have braces. But they decide to do it and it turns out that suddenly the whole procedure connected with treating teeth, all that braces we bite with, costs, for example, 50 thousand zlotys. And horror ensues. You don't know whether to take out a loan or not. Does it really have to cost that much? Has it become a bit of a fashion nowadays to have all your teeth straightened, to wear braces. To have a super white smile?

Emma Kivorkova
Well, I do not know if you are asking the right person, because I have been so taken with and enthused by functional dentistry, where everything is really important and where we are very aware of the impact that oral health has on our overall health. I will say that of course it is worthwhile and necessary. Starting with what the editor mentioned malocclusion is how huge an impact, untreated malocclusion has later on our adult life and on our overall health. Starting with the way we breathe, that we are hypoxic, the way we breathe through our mouth. Where the whole oral microbiome is disrupted, and that affects the gut microbiome. And that translates into lots and lots of different conditions that we then see.

Monika Rachtan
These include cardiovascular, oncological and neurological conditions.

Emma Kivorkova
One at a time. Cancer, difficulties getting pregnant. The whole lot, the whole range is. And now it's functional dentistry that very nicely shows, makes patients realise that we don't come to the dentist to take care of our teeth, we come to the dentist to take care of the whole stomatognathic system, which is everything that goes on in the mouth. It's not just the teeth, it's the tissues surrounding the teeth, it's the tongue, it's the saliva. An extremely important part of both oral and whole body health. What I've said, orthodontics is my hubby and what a huge impact a correct bite has on how the whole body functions is something they can really appreciate. Those patients who have already undergone this treatment and have a comparison. Or those patients who just go to the dentist and find out that as a result of their bite defect not having been treated. Exactly, they are more prone to carious cavities. They just have temporomandibular joint problems, migraines.

Monika Rachtan
Do you remember a patient who just came in for a check-up? Let's say she had white teeth. There weren't many cavities, but she just happened to see the doctor and during the conversation it became clear that there was a health problem that was unexplained in her and she had been looking for answers for many years. And the doctor looked at it and said, "These are malocclusions and it needs to be done". And realistically after that it translated into her quality of life, getting that problem fixed.

Emma Kivorkova
Well, of course it is. And just now it's like we have a bit of a reputation that my team specialises a bit in difficult cases. I remember once, after an appearance on some morning TV programme, I was approached by a patient who had come for a consultation, she said she felt that maybe I would be able to help her and she talked about the fact that her tinnitus had been with her for a long time. And she had visited ENT doctors, neurologists. she had been to all of them and had not been able to cope with it.

Monika Rachtan
It is also worth telling our viewers not everyone knows what a serious problem noise is. Because I have this ear here, it hums. And believe me, sometimes I find it hard to collect my thoughts, it hums just a little, and these people hear the tinnitus all the time. It's something that affects them, they can't drive, they can't concentrate at work, they can't sleep, they get depressed. This is really a very serious problem.

Emma Kivorkova
Nervousness, irritability, a whole cascade of different and mental, and emotional, and physical symptoms that accompany this. And we started therapy for this patient. And after three months the patient stopped having tinnitus. And then she kept coming in and saying that she couldn't get over it, that why were they sending her like this endlessly to more specialists? Why didn't it occur to anyone to actually make a referral to a dentist who would just take care of her in such a holistic way, take care of her? Well, and there are a lot of such patients. Migraines, another topic where often it's just the same after neurologists go for acupuncture, whatever these patients don't try. And it turns out to be trivially non-trivial. The problem was in the mouth and all you have to do is take care of the proper function of the bite, the chewing, the proper bite and suddenly these migraines are much less frequent. And gradually, gradually you can also put an end to the problem altogether.

Monika Rachtan
And did you say to the doctor that often the dentist can take a holistic view and, de facto, it is already my conclusion to cure a disease that the doctors of other specialities have not been able to identify, to create recommendations that would be appropriate so that the patient stops suffering from pain, so that the patient stops getting sick. But you have also just spoken about this phenomenon of being referred from specialist to specialist. I think there's this distinction that there's a world of doctors, these body doctors and medics and so on, And that's more in the minds of people in general and people who are involved in medicine. And there on the other side there are these dentists and that even if here those think about some specialist teams, that is there the involvement of the neurologist, the cardiologist in the care of the patient, it doesn't occur to them at all to still take the dentist into this their team and that together, together. And as you look at this very awareness of doctors, can this dentist in the mind of these other specialists be an active and contributing substantive value. A partner in the conversation about the patient's problems.

Emma Kivorkova
This is a must have. It is a must have. What makes me happy is that there are more and more of these holistic doctors who are also paying strong attention to the condition, the dentition and the oral health. And that makes me very happy. But actually this narrow specialisation in medicine is a blessing and a curse. The same is true of dentistry. We have a plethora of specialisations ontology, paedodontics, orthodontics, surgery, dentistry, a range of specialists. And it's a blessing because when someone deals selectively with a particular subject, I think they will be far better than someone who deals with everything. But this has its limitation, and years of my work have led me to the conclusion that what I put a lot of emphasis on, and my whole team is already very sensitive to, is a multidisciplinary approach. It is important to me that when a patient comes to the dentist, he or she should not just look at the individual 32-28 teeth that should be there in the mouth and whether or not there are cavities and exposed necks. Just that he should ask the question first and foremost "why? Why does he see this abnormality and not another abnormality in this patient?" And once he has seen these abnormalities, to get a team of specialists together and look at the patient together and think about what we can do together for the benefit of this patient. Like, for example, this whole longevity movement and the whole longevity movement. It is based on many pillars. Increasingly, they are saying that oral health should be one of the pillars. This is not a cliché.

Monika Rachtan
It should not, it is one of the pillars. This is undeniable, because it goes back again to what the doctor just said, which is that it is what it looks like.

Emma Kivorkova
A human being, is a whole. And if I, for example, had this interesting observation. I have three children and I have a big age difference And as I went to the paediatrician with my older daughters, I wondered when someone would look into the mouth that I don't come and say I'm a doctor. When will someone look in the mouth and pay attention to that dentition. On the balance sheet such things are not done. I, in general, have often asked myself how it happens that we skip it, skip a stage or e.g. Just do you go to the dentist?

Monika Rachtan
That's how I don't look at it at all anymore.

Emma Kivorkova
Now with my younger son, for example, the paediatrician looks in regularly, even though he already knows that I am a dentist by profession. He looks into the mouth, he checks how this dentition looks, how the mucous membrane looks, how the tongue looks. There is no way to properly diagnose a patient, be it an adult or a child, by omitting the mouth. This is the beginning of the digestive tract, this is our whole digestive tract. In fact, it is actually one of the few parts of the body that has contact with the outside world. The skin is known, and the mouth is the beginning.

Monika Rachtan
I still thought of this one situation as the doctor said about the paediatrician and I don't associate it either. I've never yet used an antibiotic on my daughter, but I think of myself as a child, for example, coming to the doctor with my mum using antibiotics. And the doctor prescribes another, another packet of antibiotic and that he should look in the mouth or whatever. And that is what we are sensitising you to, that if you come in for another dose of antibiotic, or you come in after antibiotic therapy with some symptoms. It is also worth paying attention to look there, because what the doctor said, but also always with an appeal to all parents in general, that we also admonish, right, doctor, that it is allowed to say to the paediatrician at the balance sheet, Excuse me, please look into my child's mouth again.

Emma Kivorkova
Well it would be worth it, of course, but paediatricians do it themselves, and if they don't do it already, I would honestly prefer to go to a dentist and let a professional do it.

Monika Rachtan
But it's of course like that visit. What I don't deny is that at the paediatrician on occasion.

Emma Kivorkova
So that it comes to mind to look into the mouth and see, for example. Leaving aside caries-related topics. But let us return to malocclusion. A child who has clearly narrowed dental arches when he has clearly. Already in a young child we see that there is a malocclusion, then the child will very often be hypoxic, will have a number of systemic symptoms, which somewhere should connect these dots And such a paediatrician should look into the mouth and see if perhaps it would be worth referring to an orthodontist, just to verify whether the function of the masticatory organ allows the child to develop properly, whether the child does not sleep with the mouth open, whether the child has the right track, breathing, whether it swallows properly? All these things matter, because the way it works depends on this. Further sections of the digestive tract will work. That's why I think that this functional medicine and this functional dentistry, which people don't really know what functional dentistry is yet, is the future.

Monika Rachtan
You want to tell me, and more so our viewers, that a dentist who treats holes in teeth, because for the average person it is such a doctor, that he can check whether my child is chewing and swallowing food properly and, for example, he can help me to solve the problem of deficiency of some vitamins in the body, because it turns out that this is the problem here and that I should not look for this diagnosis in a laboratory, from a doctor, from a magician, from a shaman on the Internet, but from a dentist.

Emma Kivorkova
Exactly right. Exactly like that. We are just looking at whether it is a child or an adult. We look at the whole thing. A child, for example, comes to the dentist and has multiple cavities. Caries has inflammation, periodontitis, and there are children who have periodontitis at 100% already at a young age, they will be disturbed, have blood results, there will be disturbed bowel function, the whole digestive tract. Well, and these consequences are very many. So I always encourage. Anyway, in general, I think also my personal health experience has made me think today that the responsibility for our health is our responsibility. You can't put it on the doctor. If we ask a question and the doctor ignores our questions or dismisses it and thinks we're being clever or asking a stupid question, then maybe it's worth considering a change of doctor?

Monika Rachtan
Which is also what I always remind you, my viewers, that today we have. Some people don't understand the comparison that I use, but I'm sure your doctor knows the comparison, that today we have a market of the employee, so I also think that we have a market today of the patient, that even though there are some places where you list different doctors, you give them different opinions, they are not always true either. It is nevertheless us today who have the right to choose, especially when we use private medical care. And it is no sin to tell a doctor. I don't like the way you treat me. I will go to another doctor. No one will be offended by that if we do it in a cultured, respectful way.

Emma Kivorkova
Even if he gets offended. So what?

Monika Rachtan
This is where our health is concerned.

Emma Kivorkova
That is exactly right. Our health is more important and it is more important to get answers to our questions. It is one of the most important jobs of the doctor to know how to talk to the patient. To take a history. An extremely important part of the whole treatment process, but also to talk, to answer the patient's question, because that is how we build trust. Also, if the patient can talk openly with me, say that he smells bad from his mouth or that I don't know, he has problems, that he feels dry mouth all the time and a whole bunch of different problems that are sometimes embarrassing. It shouldn't be such a problem because he comes to the doctor, he should be able to talk to the doctor about everything.

Monika Rachtan
The kind of care you are talking about is not standard in all places in Poland, even if they provide private services. I would like to ask what such a model visit looks like at your doctor's, for example, or at the people who work in your team, because I know the standard of care you are talking about, but I also know such a standard of care that there is a good morning, the doctor sits at the computer and writes something down after the previous patient, then the patient sits down on the dental chair, the lamp is switched on, there it is, please open your mouth and there is no conversation. And what does it look like with your doctor? Do you actually meet in the chair at the beginning and chat for a while?

Emma Kivorkova
Exactly yes, before the patient sits down in the chair, I try very hard to disenchant this myth of such a scary dentist. I take great care of the whole experience, the whole experience of that patient from the moment they walk into the clinic, because often our generation is fearful. In general, crossing that threshold of the dental office or the clinic. So it's important to me that such a patient feels taken care of from the beginning and feels that they are in a safe place. And most often, when the patient sits down, I want to talk to him. First ask him what brings him in, what experience he has, what he expects from us and only then smoothly possibly move on to the examination. And I also watch the patient, when he says how the child comes in, I look at the posture, whether that head is pointing more forwards, whether the child is hunching. This also tells us a lot about what problems, what problems we can expect already in the clinical examination in the oral cavity. And for me it is very important that this patient trusts me, that he builds a relationship with me, and what I care about is, when a first-time patient comes in, is that he goes to doctors in my team who are just more such doctors, holistic doctors, they already look at the patient as a whole, they observe what the speech looks like, they observe what it looks like in the oral cavity, what the tongue looks like. They look at the whole, not just the teeth and whether there are cavities there or not. And then such a doctor, after carrying out the appropriate diagnostics. It is also very important that this diagnosis cannot. Certain stages of this diagnosis cannot be skipped. Often it is the case that a patient comes in to say that I would like a CT scan to be carried out, rather than a classic pantomogram, then the patient is so surprised why a CT scan at all? Because we are able to capture a lot more and identify the patient's problems much more precisely. And if I do a pantomogram on him and in a moment you see that it's just an overview picture, where we can only see roughly whether there are problems or not, then in a moment to diagnose it, do another examination. Pointless.

Monika Rachtan
Well

Emma Kivorkova
But that is also what I am saying. That's it, making these patients aware is a very slow process. And once this patient has passed this diagnosis, then the team puts together a treatment plan.

Monika Rachtan
And this team is precisely not just a conservative dentist, but it is often a surgeon. It is often a periodontist, a prosthodontist

Emma Kivorkova
Orthodontist, a very important part of the whole team too, but with me. I know this may come as a shock to most listeners, but I have been doing this for 8 years now. I already today cannot imagine guiding a patient, an adult patient, and sometimes teenagers, but an adult patient who comes to us with teeth missing, with malocclusion, without cooperation with a physiotherapist.

Monika Rachtan
Then what does the physiotherapist do with such a patient?

Emma Kivorkova
Again, we come back to the fact that we are a whole. If we have impaired function in any one aspect, it will also affect other aspects of health. If we have a malocclusion, muscle function is affected. They work in the wrong way. And now how do I go about treating malocclusion. And I will leave out the whole aspect of muscle tone and the whole holistic setting. It's that patient who may either be more prone to relapse after treatment, or may have problems adapting to the new setting. That is, for example, a patient comes in at the age of 50. To illustrate this, at the age of 50 he has some missing teeth, he's missing a few teeth, the remaining teeth are worn down, crookedly aligned and the prosthodontist immediately sets about making a prosthetic work and this patient is released to go home, then he will either come back and keep coming back to us endlessly with failures, that something there is crumbling, that something is breaking, that he endlessly has to come in for some adjustments or he has difficulty adapting, he starts to have deteriorated pronunciation. We also have a speech therapist in our team who works with patients not only with children, but with adult patients. He re-educates so that the results of our treatment are as good as possible. What is the rehabilitation of a trauma patient like? It is not just the rehabilitation that the physiotherapist carries out. It is the whole thing, supplementation and nutrition. Everything is important, isn't it?

Monika Rachtan
I think that in general, what you are talking about, the transition of the viewers themselves, the patients to such an order, that just a tooth is the same bone in our body as, for example, a hand, and that it is the same, that we can't treat it as, because maybe by the fact that our teeth fall out in childhood, we treat them in such a way, that well it fell out hard, And here, however, it turns out that it really has a huge impact. As the doctor is now talking about this physiotherapist and this alignment, I felt it in my bones that it really can make a difference.

Emma Kivorkova
It is also often a huge support for orthodontists, for example. With large malocclusions, when we see, we see a big difference when the patient is guided in support, But it's also, well, not every physiotherapist has to be a physiotherapist who specialises in the head, neck section. And I have the comfort that we work with physiotherapists and they are phenomenally supportive of the treatment of both orthodontists and prototypes. And so I years of working with patients has just made me realise that success is when that patient is treated as a whole. He or she needs to be looked after holistically. How can I not refer a patient before surgery for a blood test, to see how their vitamin D3 levels are. I already consider it a mistake. If a dental surgeon does not ask his patient to have their vitamin D3 levels checked before a surgical procedure is carried out, before implants are grafted.

Monika Rachtan
But it's also your doctor. Again, it's about that awareness of the patient, because and responsibility for their health and also a little bit for their money, because once such an implant is already...

Emma Kivorkova
Rejected?

Monika Rachtan
Yes, but my point is that the patient will already have it, there will be rejection in a moment. It's a grudge against the doctor, because surely he did something wrong. You have to spend resources on it a second time, Well, because you have to. You have to sacrifice your time, some pain. Although the doctor will probably tell me right away that modern dentistry shouldn't hurt And that's very important too, but it's a whole unpleasant experience. And on the other hand, you can go to the lab, the Oratory to have that vitamin D3 level determined. I don't have the foggiest idea how much it costs now, but it's in the region of £100, maybe £150. A test and it saves us a lot. It's just that, again, we have to want to and sort of not come up with the idea that someone is trying to rip us off or something like that.

Emma Kivorkova
It was all my experience and especially I think the foundation made me understand, because we used to do a lot more research projects. What the pandemic did was that there was a bit of a limitation on what we could do and ok, well then we have to shift to education temporarily. And in fact, when we already have probably over 100,000 kids who have been trained by our foundation, I realised that this is the most important pillar of change when it comes to the state of Poles' teeth, because the awareness has to, has to change, that if the dentist we go to doesn't, doesn't inspire such confidence that I can ask him or, for example, ask the question: what can I do, doctor, so that the treatment, so that the likelihood of this treatment being successful, is greater. And see what this doctor says, does he say? If you smoke, stop smoking and use an antiseptic rinse. Well, that wouldn't be enough for me today. I would expect a doctor to talk to me. He will tell me about the different elements of supplementation before during the treatment. What can I do? The whole holistic approach. I, for example, tell the patient that after the procedure the couch and bed lifestyle. But I explain to him why. Because if I just tell him couch-bed lifestyle. He'll think it's just that kind of chat.

Monika Rachtan
But why should we rest after such treatment?

Emma Kivorkova
This is because the body needs to use a correspondingly large amount of energy for the healing process, for repairing, for healing. And now, if we take this energy away by taking to washing the windows the next day after returning from treatment, or taking to looking after the whole family rather than ourselves, then we are taking away the strength of our body to heal itself. So it's like I've just been saying, that kind of holism.

Monika Rachtan
In Poland, it's a bit impossible, because each of us is a Polish mother who goes, does her business and then comes back to her children and does all the things she has done before. So that kind of giving yourself time, but it's again what we've already said a few times, which is responsibility for your health, responsibility for your life. And the doctor, of course, can make recommendations, but she's not going to go home and lie down for that patient or brush their teeth for them, because it's all up to us. But I am also wondering about this issue, because you were talking about this trust, and I used to wonder which doctors, which specialities of doctors we should have the most trust in and should be closest to us. Well, logically, that is the assumption. On the other hand, I wondered what it is really like with such a doctor. The one we see most often is the one who has the most time for us, and it seems to me that it is this dentist who is such a general practitioner, because, however, if someone already takes care of their oral health in the way a dentist commands, i.e. once every six months they go for a check-up, they brush their teeth, they devote resources to using good quality oral care products. He's attentive to all the changes, he does examinations, then we meet every six months. I don't even go to the gynaecologist every six months, only once a year. Fortunately, I don't have to. On the other hand, it turns out that this is the doctor who is a bit closest to the patient.

Emma Kivorkova
I would very much like this to happen in Poland. I would love it if statistically the majority of Poles visited the dentist every 6 months. That would be great, and at least a hygienist, a hygienist who will check and possibly catch a problem, will refer to a dentist. This is not such an obvious thing at all. On the other hand, it has to be a doctor with whom we feel comfortable enough to talk about everything. My dream would be for such a doctor to be a family doctor, because it should be the greatest holistic doctor, who will just pay attention, refer for an examination, know how to read the test results properly, pay attention to every deviation that we see there. The whole of medicine in general has to move towards, in my opinion, the personalisation of such a more individual approach. Because if we know that for many, many years, the norms, both in terms of test results, but also the norms, when it comes to the whole treatment process, were based on men and women, with all their complicated, hormonal background and everything, were not really taken into account at all. That, to me, is already an indication of how much needs to change. In medicine in general, but also in dentistry, for this personalisation to take place, to look at everyone individually. And in this respect, I think that dentistry will come to the fore a little more. This is because when the patient comes in, there is a whole range of treatment methods. There is a whole range. And if we are lucky and we find a doctor who is inquisitive, who does not do the interview, but listens.

Monika Rachtan
He analyses, he connects these dots, these facts that the patient is talking about because I've been to a cosmetologist recently. It's interesting in general. I've been to a cosmetologist recently. I very much salute my cosmetologist who interviewed me, which lasted an hour and a half. I was getting a bit tired, but I thought wow! She asked me everything and she said After this hour and a half, can I tell you what your skin problems are due to? And I say Oh my gosh, and I imagine this visit to the dentist in the same way. The same way I imagine this visit to the primary care doctor, there are so many of these questions and these nuances that can change this path of thinking.

Emma Kivorkova
Exactly, sometimes patients at our place also get angry, upset. That when they come is this interview that first. Especially this interview the patient fills in himself. And then we still come with this patient. Together Through these questions sometimes they get angry. On the principle of "why?" Sometimes these questions seem to be off the wall. For example, I don't know. A question about whether bruising on the body is common? So a whole bunch of questions that seem to be total. Like it doesn't apply to a visit to the dentist. And that's what makes up the whole picture, the picture of what the patient comes in with, how their body works, where the problems are. If the patient has a hormonal disorder, this will also be reflected with what we see in the mouth. This is how we should all approach patients. It just needs a lot more time to change what the amount of time we spend with the patient, talking to them, looks like. What the editor said, so that a patient comes in, there's someone writing something, they sit down in the chair. Well, when he finishes, he says something, what he's done, that's cool. And she doesn't direct him to reception anymore to pay the bill and make another appointment. That's not how it should be. It's the patient's health that comes first. He is supposed to know before we touch him. What we are going to do, what we know, what we are looking for. So that's something else. And I am counting on the fact that what I have very much on my heart at the moment is that I would like to do my best to make this functional dentistry function in the right way, so that it becomes the norm and not something novel.

Monika Rachtan
And a luxury. There's one other thing that comes to mind in the context of this holistic, as you know I think you're guessing, because we talked for a while. You've also been going through the materials that I've put together, that I'm very strongly sensitive to any oncological disease and I think there's a lot of work that can be done by different specialists to help the patient get a diagnosis quicker. And, of course, about the fact that the bacterial flora of our oral cavity has a huge impact on how it turns out whether we develop a cancer. That is one thing, but the other thing is that when we go to the dentist, this is the doctor who is the only one. He shines a lamp in our face and can spot melanoma on our face. Can spot the cancer.

Emma Kivorkova
Leukaemia, for example, often sees its first symptoms in the mouth and an attentive dentist can be the first doctor to refer a patient for an examination and the patient will know that they have leukaemia. Also a thyroid disorder, a specific type of cavity, can indicate that the patient has abnormal thyroid function. We are able to pick up that someone has either reflux or has bulimia, for example, and possibly discreetly point out that there are already physiological symptoms of the aftermath of a psychological problem and wisely direct to a doctor who could address the underlying problem.

Monika Rachtan
What kind of reactions do you encounter when, for example, you make such a diagnosis, because again, I realise that probably the patients of your clinic are informed people who want to take care of their health. But now I imagine the situation of a 16-year-old with his mother in the dentist's office. The dentist notices that there are symptoms that may indicate bulimia. I relay such information to the mother in a discreet way, e.g. Not in the presence of the daughter. And I hear who are you to tell me that my daughter has bulimia or who are you to suspect cancer in me?

Emma Kivorkova
As I say. Well, it will probably be difficult to answer this question, because I am fortunate that I work on a daily basis with patients who are aware of this, who are looking for care at just such a high level, where someone will look at the whole picture. However, through the foundation, there have been situations when, after a visit to, for example, a village, the patient receives a card which says that it is suggested to visit the dentist as soon as possible to have the teeth treated and the milk teeth replaced. And the dentist calls the foundation and shouts at the staff member that what are we thinking, that we are coming and doing such a shoddy job, because the patient comes to her afterwards and says that he has cavities, and yet he was at the appointment a month ago and was told that everything is ok, because there are millipedes which are about to fall out.

Monika Rachtan
That is, this patient was told that it was not worth treating them.

Emma Kivorkova
Exactly so. And at this point I am wondering who I am supposed to make the patient aware of, or the dentist, who will wave his hand and explain to the patient that this is an infectious disease and from close contact, where the tooth is about to fall out, but here next to it a new permanent tooth is already erupting. Next to this baby tooth and it will become infected. And there is either a huge risk of infection and a cavity in the permanent tooth. Therefore, when I see a patient who, for example, has severe problems, advanced periodontal disease, this is colloquially called periodontitis. This immediately turns on a very red light for me, because in fact this patient should be wisely managed by an internist. This patient must be particularly examined for metabolic diseases, cancer. It has been proven that there are specific bacteria in the mouth, specifically one bacterium that is found in tumour masses in colorectal cancer with pancreatic cancer being one of the worst cancers that someone can have to deal with. But there have also been cases with breast cancers where bacteria have been found in the tumour masses that are responsible for periodontal disease, so especially if someone has periodontal disease they need to pay much more attention to their overall health and get themselves checked and checked more often, and above all deal with this disease at the tooth because if left untreated there will be a whole knock-on effect in the body.

Monika Rachtan
Doctor, and what are the most common dental myths you hear in your practice?

Emma Kivorkova
Mostly, I mean all the time the fight against the fact that milk teeth are not worth treating. The thing that pains me is how paedodontists, or doctors who treat children. I bow my head. I don't know if I, if I had the choice of only treating children and nothing else. I don't know if I would. Because the emotional, mental and physical effort of such a doctor in working with a child is incomparable to that of an adult patient who comes in even with dentophobia and then, for example, when the patient, the parent asks if these are milk teeth, why does it cost so much? I think it should cost much more than treatment of permanent teeth, because the effort and the difficulty of working with a young child and the awareness of a wise doctor that he has to do everything so that this child enters adult life without dentophobia, so as not to alienate him. It deserves to be treated differently by the parents. Not the treatment of deciduous teeth, well, we have already said that. Well, as far as adult patients are concerned, well it's a myth that losing one or two teeth is nothing terrible.

Monika Rachtan
Well, again, it's malocclusion, which the doctor also said that it all works out there after all, doesn't it?

Emma Kivorkova
Cascade, of course it's all connected. Every single tooth is important, even the WHO, which I don't think all theses are right or wise. But just the fact that the loss of one tooth equals the loss of one per cent of health I think is a great analysis. So if statistically ...

Monika Rachtan
Insurance companies are not happy now.

Emma Kivorkova
Probably yes. A sixty-year-old statistical Pole who is missing most of his teeth. These are the times we live in Poland all the time. So far it is easy to count how many percent of his health is already missing. I also think it is very important to raise awareness that, and I wanted to get out of the mindset that you go to the dentist to have a filling put in, to have your teeth treated. We go to the dentist for oral health. That's how I would like it to start working in the mentality, in the consciousness of the Polish people.

Monika Rachtan
And I think I would like to see in the mentality of Poles the thesis that we are individually responsible for our health. And what kind of doctor we choose, how often we go to him or her and how he or she treats us is largely up to us. And when looking for dentists. Let's look for doctors who deal with our health holistically, so that we can be sure that the state of our mouth, the state of our oral cavity, will not adversely affect the health of our whole body. My guest today, but above all your guest, was Dr Emma Kiworkowa. Many thanks to the doctor for her visit to the studio.

Emma Kivorkova
I thank you very much, Madam Editor, for the work you are doing and for making patients aware that we are responsible for our own health and that we deserve doctors to help us on this journey to health.

Monika Rachtan
And they treated us in partnership. Because I think that is also very important. Thank you very much for your attention. This was the 'Patient First' programme. My name is Monika Rachtan and I invite you to my social media, but to your doctor's social media as well, thank you very much.