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prevention International magazine for oral health No. 1, 2018

| special: dental hygiene in Belgium to be needed to make the idea of treatment approachable or acceptable. Unfortunately, waiting for this trigger often leads to the loss of the tooth instead of its repair. From the patients’ point of view, I am convinced that some of them insist on not being treated for things they do not complain about, as they see these treatments as unnecessary. If I personally have to undergo an annual medical check-up, I would hope that all the exams needed are performed, as this will set me at ease. Why then does this appreciation not apply to oral health? What are some of the oral hygiene instructions and pa- tient motivational actions that you would recommend? Thanks to research and clinical findings, lifestyle habits, genetics, stress, hygiene, medication, age, nutrition and different systemic factors have been shown to accelerate the development of periodontal disease in the presence of biofilm, activated by a hyperreactive or even a hypo-reac- tive immune system response. It is a fact that this sort of risk analysis has become part of the graduate curriculum, including counselling on healthy food habits or how to quit smoking, detecting periodontal risk through assessment, using caries detectors, and so on. Firstly, the patient should demonstrate his or her home care habits using his or her own toothbrush. We distinguish four levels of patient information needs: the lowest level is the patient who is almost totally ignorant about proper home care; the second level is the patient who brushes his or her teeth on autopilot without paying attention to any technique, time duration or interdental cleaning; the third level is the patient who regularly cleans even the interden- tal spaces, but unfortunately not frequently enough or not with adequate instruments; and finally, the fourth level is the patient who performs extremely well and needs none or only minor adjustments, for example tongue brushing. In accordance with the technique of motivational inter- viewing, we build up a conversation with the patient while giving instructions, waiting for approval, repeating and counselling. One needs two or three control sessions to check his or her dexterity and oral cleaning performance. Plaque disclosure remains a confronting but very effective tool to show the results of the patient’s cleaning habits. Finally, the dental professional should show enthusiasm and keep on repeating until there are visible improvements. The next question is the most important one: is this prob- lem acute enough that it should be treated immediately, in the very near future, or can we wait and see how it de- velops? This is risk management and it is dependent on multiple factors. Often, prevention is neglected in dental practices in fa- vour of diagnosis and restorative treatment. How can dental professionals implement prophylaxis in their daily practice, especially primary prophylaxis? I would say, rather, that prevention is not neglected. Sixty-five per cent of GDPs provide information about oral hygiene as a standard procedure. Depending on compli- ance, the GDP may decide to spend more time on patient guidance. This requires delicacy, as one cannot tell from a patient’s face how motivated he or she is, nor what he or she is interested in. This is not often asked of the patient, so one could rather say there is not enough time spent on communication. I invite practitioners to do an experiment in their waiting rooms. While the patient is waiting for his or her appoint- ment, he or she can be given a short questionnaire asking him or her to write down in a few words his or her under- standing of proper home care and his or her personal rit- ual. The patient can then be asked if he or she would be interested to know more about it. We use this method in our clinic. In the waiting room, patients have time to reflect and one might be surprised at how interested patients re- ally are if one gives them the opportunity to communicate and to prepare their questions in advance. To be honest, I think that primary prophylaxis is impossi- ble to achieve because we do not control all the influencing factors, of which some can be health- or patient-related. It means that we need to try to prevent people from de- veloping caries or periodontal disease. This is somewhat futile, since caries and periodontal disease are the most widespread infectious diseases present in almost every patient. Twenty-five per cent of 5-year-old children have bleeding gingivae, and this figure rises to 55 per cent for 15-year-olds. Primary prevention is like placing speed cam- eras on highways: it works all the time and for everyone, it is highly effective and inexorably justified. Today, I heard in the news that, thanks to these speed cameras and other regulations, the number of persons killed by traffic every year is diminishing. This is primary prevention. However, I strongly believe in secondary prevention; it is the dentist’s duty to examine and to intervene, preferably before detri- mental clinical signs occur. From your point of view, does the dentist spend enough time on the diagnosis of a disease? How important are home care and high-quality oral hygiene products such as those of CURAPROX? Of course, dentists are dutiful people who are concerned with their jobs. Spending time to ensure correct diagnosis is their core business. Examining patients means explor- ing and looking for mostly hidden troubles or discomforts. It is a fact that oral hygiene devices are not considered as pharmaceuticals and they therefore don’t have to be thor- oughly tested. If a company designs a nice, good-looking toothbrush, it is allowed to produce it and sell it, even if the 44 prevention 1 2018

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