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prevention International magazine for oral health No. 1, 2018

practical prophylaxis | Therapy, diagnostics, prevention —what are your concrete rec- ommendations? We cannot predict reliably enough how much of a risk a pa- tient has of developing symptoms in the form of decaying lesions or periodontal pockets. It is even more difficult to do this for specific areas of the tooth. And even if we could, things can change at any time. The risk of too little or too much preven- tion on the wrong tooth surface is therefore very high. This applies to erosion, abrasions and infractions in the same way. That’s why it is more efficient in today’s dentistry to wait for symptoms to develop, providing site-specific risk information. However, if we wait long enough for the symptoms to be clinically visible, it’s already too late and we fall back on dentistry from the nine- teenth century. If one has the diagnostic opportunity to rec- ognise symptoms long before their clinical manifestation, such a concept suddenly becomes very interesting. We know that it takes years for clinically evident symp- toms to develop in caries and periodontitis alike. If diagnos- tics are carried out with sufficient reliability and if diagnostic methods are available that catch symptoms in the subclin- ical stage, one will have enough time to tackle these with non-invasive methods. As dentists, we only tackle the symptoms of caries with our restorative methods. For technical and practical rea- sons, we used to only treat symptoms at a later stage, when the decaying lesions had already developed into cavities, because diagnostics weren’t as advanced and restorative therapy was based on macro-mechanical prin- ciples. We needed the hole so that we had something to fill. Today, this concept hasn’t really changed in principle. From a professional perspective, we are still treating symp- toms, but we have other diagnostic tools and therapies, so we don’t need macro-retentions for restoration. This lets us act much earlier and use non-invasive therapies. Should we be concentrating on primary or secondary prophylaxis? Individual primary prophylaxis is the foundation of every- thing, but nobody’s perfect. With the primary prophylaxis tools we have today alone, we will not be able to save humanity; despite our best efforts, symptoms will arise. That’s why our concept is not solely based on primary pro- phylaxis. It also integrates secondary prophylaxis, which aims to halt symptoms non-invasively in the early stages so that they do not become more clinically serious. Non-inva- sive secondary prevention seems to me the tool of choice, given our current circumstances and the resources we have available today. What role does individual home oral hygiene play in caries prophylaxis in your opinion? Individual home oral care by the patient is the most im- portant aspect for me. It might sound presumptuous, but many people can’t brush and don’t know which tools, products and techniques are the best and most efficient for their individual situations. I am convinced that oral care at home can only have a long-term effect when it is over- seen by a dental professional. This professional cannot heal the patient, and it wouldn’t make sense for the pro- fessional to perfectly remove the patient’s biofilm each day, as this would require that the patient come to the prac- tice every day. Even if he or she could afford this, it would lead to public transport chaos and would make very little sense. Therefore, it is more sensible to delegate this job to the patient and inform, educate and monitor him or her as needed, as well as correct and motivate when necessary, not just once, but again and again. Manual or electric toothbrush, floss or interdental brush, toothpaste with or without fluoride—the individual case should stipulate what tools are needed. As dental profes- sionals, we have the knowledge to provide the correct di- agnosis and to advise the patient on which tools, products and techniques would be the most effective, quickest and cheapest for his or her individual circumstances. We can still get involved if professional therapy is needed and be- fore clinically visible symptoms arise. Finally, how’s your own oral hygiene? Very good. Although I had to live through the dentistry of the 1960s as a child, I still have all my own vital teeth and they’re all doing well. It helps that my wife is a dental hygienist. She’s the best thing that could have happened to me in many respects. prevention 1 2018 65 Prof. Ivo Krejci© Robert Adrian Hillman/

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