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prevention International magazine for oral health No. 1, 2017

practical prevention | indivdually trained oral prophylaxis programme facilitates individual training with regular check-ups and corrections to the prophylactic techniques learnt. While iTOP started as a one-day training pro- gramme with 15 people in 2006, it now boasts 200 courses in 44 countries with 15,000 participants. Yes, 15,000 general practitioners, periodontists, oral surgeons or dental hygienists who relearn for up to five days how to manage optimal oral health for their patients. The theoretical part includes an introduction to biofilm management, pa- tient motivation, cleaning techniques and tools. Today, the courses range from intro- ductory to advanced and teacher levels. The higher the level, the smaller the group will be. A yearly recall course ensures the maintenance of one’s individual skills and own oral health, just as at least twice- yearly recalls should occur in the dental practice. In all courses, a great deal of time is spent on the exchange of ideas and dis- cussions surrounding the most effective, atraumatic and acceptable prophylaxis possible for patients. Ideas, theories and practical concepts from all over the world have been collected to advance the pa- tient experience, another unique feature of the educational programme. The iTOP philosophy envisions a world of motivated and educated patients and professionals, both of whom under- stand the need to use soft toothbrushes and interdental brushes daily. How can a dental professional get started then? mine the accessibility and widths of their own interdental spaces. They identify the largest diameter that can pass between the teeth without causing discomfort or trauma. Once they have been equipped with a cleaning tool that is effective, atrau- matic and acceptable, they can pass this knowledge on to their patients through a mandatory routine examination of each interdental site. Establishing a patient’s ability is one part of a routine examination. Improving a patient’s motivation, however, is not as easy to achieve. Damage to the interdental papilla and abrasive trauma to the den- tal surface essentially result from a lack of motivation and training. Furthermore, bleeding may stop patients from using interdental brushes even though this bleeding will stop after several uses. At the same time, every dental professional knows that oral and periodontal diseases largely result from a lack of motivation to brush twice daily. All iTOP seminars de- vote a major part to individual instruction and motivation. By correcting and repeat- ing the correct cleaning techniques as much as possible, everyone can achieve oral health for a lifetime. However, the road to lifelong oral health requires change. Change requires motivation. And motivation requires repeti- tion of education and training. The conclu- sion: lifelong oral health without education is impossible. So, who will be willing to lead this change? Change requires motivation Essentially, iTOP starts with changing the dental professional, helping him or her see the patient’s perspective. Let us take interdental cleaning as an example. The dental office experiences two major problems with interdental cleaning every day: patient ability and motivation. An individual’s ability to clean interdentally can be taught easily. An interdental brush that is sized correctly for each interdental space is easy to handle and atraumatic, but effective and acceptable. The iTOP programme follows this principle: partici- pants first learn the theory and then deter- Prevent, not repair what could have been prevented Prague, Czech Republic, 20 °C on a late spring day: the second theoretical part of the iTOP for students seminar has just ended. Every six months, students and recent graduates of dental schools are invited to attend an exciting weekend in the Czech capital of Prague. They learn more about cleaning techniques, moti- vation and ways to implement the pre- ventative mindset in their future practice. And, yes, they have a few beers because this is what the Czech Republic is also famous for. We sit at the table with the head instructor and father of iTOP, a true pioneer in prophylaxis. Born in 1946 in Prague, Dr Jiri Sedelmayer speaks in a calm, yet vibrant, voice recalling the tales of old your grandfather told. Last year, he celebrated 30 years as a dentist, an occa- sion on which he could not resist a glass of wine and a few cigarettes. In a world of perfect smiles, every dentist continues to be human. In a world of constant change, human beings remain creatures of habit. Sedelmayer has spent most of his professional career repairing teeth. When he started working at the emergency room at the University of Hamburg in the 1980s, he realised that something was wrong. Every night, Sedelmayer witnessed so much suffering, severe periodontal dis- ease and caries among educated busi- nessmen, some of them crying from pain. Those businessmen expected Sedelmayer to fix what could have been prevented in the first place. “Most of the time, the only reason for this pain was a lack of mechanical plaque control. Hundreds of people that I treated simply did not brush their teeth properly. It was not taught to them—and it was not taught to me when I was studying.” About 30 years ago, ten of his peers would have shown him ten different Bass techniques. Most of these colleagues also started to bleed as soon Sedelmayer applied a new instrument called an interdental brush. Within two weeks, the inflammation had stopped and so had the bleeding. They were thankful for his advice—only to discover the rising potential of titanium implant systems and computer applications for the treatment of more patients. No doubt, dentists disagreed on the concept of prophylaxis back in the 1980s. Very few textbooks or guidelines existed, and opinions ranged from calculus re- moval to flossing and medium-hard brush- ing once a day. Sedelmayer understood that the concept of preventative dentistry could only be founded on proper tooth- brushing. As a consequence, he started to change not only the way dentistry was taught at the University of Hamburg, but also the hierarchy of dentistry itself. “Why 46 issue #1

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