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prevention International magazine for oral health No. 1, 2018

| practical prophylaxis “Prevention is not just for children and young people” An interview with Prof. Ivo Krejci on lifelong dental coaching Three years ago, Professor of Cariology and Endo- dontology Ivo Krejci (University of Geneva, Switzerland) published an article titled “Lebenslanges ‘DentalCoaching’ anstelle ästhetischer Zahnmedizin” [lifelong dental coaching instead of aesthetic dentistry] in which he made the case that professional motivation, instruction and check-ups, as well as precise, non-invasive therapies, should be the core competence of a practice team in order to maintain oral health, prevention spoke with him about his assertions. Prof. Krejci, what is your main message when it comes to modern caries prophylaxis? Prof. Ivo Krejci: The aim of modern dentistry is not the temporary repair of heavy clinical symptoms in the form of large decaying lesions and deep periodontal pockets, but rather the lifelong dental health of the population, which I define as the absence of clinical symptoms. My article fo- cused on one aspect of this concept, namely the causes, symptoms and treatment of caries, a chronic lifelong in- fection of the biofilm, the clinical symptoms of which, in the form of decaying lesions, are still some of the most com- mon reasons for extractions. I am aware that I am speaking against the common teaching opinion, which treats caries and periodontitis as non-communicable diseases, but it would be too much for this interview to explain the reasons for this stance in detail. Besides increasingly criticised fluoridation, bioavailable calcium, acid neutralisation and harmless sugar substitutes can be identified as important factors in preventing car- ies symptoms in so far as the patient doesn’t want to curb excess sugar consumption. Three further measures are at least just as important: firstly, early diagnosis of the initial caries; secondly, the lifelong, periodical professional moti- vation, instruction and monitoring of an efficient, atraumatic home dental care routine in the sense of primary prevention; and thirdly, the use of non-invasive adhesive composite res- toration to stop or at least delay subclinical caries symptoms in the sense of secondary prophylaxis. Direct and indirect minimally invasive composite restoration complement this philosophy in patients entering into this concept with exist- ing large decaying lesions or with existing restorations. Why do we still separate periodontitis prophylaxis and caries prophylaxis? It’s difficult to say, as both problems have to do with im- munology and a pathogenic biofilm. This separation makes no sense at all. We should always speak of simultaneous caries and periodontitis prophylaxis, not of separate prob- lems. Depending on the individual patient’s situation, the focus may be more on caries and/or periodontitis pro- phylaxis, but it shouldn’t be forgotten that a lifelong pre- vention-orientated concept should take not just caries and periodontitis into account, but also erosion, abrasion, trauma, dental misalignment and infraction. You mentioned pathogenic biofilm. What do you rec- ommend: completely remove or disrupt the biofilm? The biofilm actually protects our teeth, so is vital for sur- vival. Its permanent removal from the mouth would therefore be counter-productive. Through its currently unpreventable infection with bacteria that cause caries and periodontitis, it becomes potentially pathogenic. This pathogenicity can only develop if two conditions are present: firstly, the bio- film must be sufficiently structured, which requires around 24 to 48 hours after its formation, and secondly, certain parameters must be present. An example of this is the re- peated excess of sugar in the caries process. These deductions form the basis of the preventative con- cept: we accept the infected and potentially pathogenic biofilm and do not remove it permanently from the mouth. We acknowledge that a change in the conditions—for ex- ample, through a drastic reduction in sugar consumption— would be very welcome, but difficult to implement in the long term in practice. We therefore approach the structure of the biofilm and prevent its pathogenicity from develop- ing. The solution is simple: we just have to regularly, that is every 24 hours, disrupt the structure of the biofilm inten- sively on all surfaces of the tooth. Chemicals and medica- tions don’t help a great deal, as the biofilm has very potent defence mechanisms. In your article, you spoke about lifelong dental coach- ing. What do you mean by that? Prevention is not just for children and young people. As caries and periodontitis are lifelong infections and decaying lesions, periodontal pockets, erosion, abrasions, trauma and dental infractions can arise at any age, lifelong prophy- laxis is unavoidable. This lifelong dental coaching is based on the preventative measures already mentioned, comple- mented by regular professional monitoring with high-tech diagnostics to catch symptoms in the subclinical stage, thereby allowing non-invasive therapy where needed. 64 prevention 1 2018

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