2 ◊Page 1 HYGIENE TRIBUNE Dental Tribune Middle East & Africa Edition | 5/2018 pathogenic biofilm. This separation makes no sense at all. We should al- ways speak of simultaneous caries and periodontitis prophylaxis, not of separate problems. Depending on the individual patient’s situation, the focus may be more on caries and/or periodontitis prophylaxis, but it shouldn’t be forgotten that a lifelong prevention-orientated con- cept 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 recom- mend: completely remove or disrupt the biofilm? The biofilm actually protects our teeth, so is vital for survival. Its per- manent removal from the mouth would therefore be counter-pro- ductive. Through its currently un- preventable infection with bacteria that cause caries and periodontitis, it becomes potentially pathogenic. This pathogenicity can only develop if two conditions are present: firstly, the biofilm 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 repeated excess of sugar in the caries process. These deductions form the basis of the preventative concept: we accept the infected and potentially patho- genic biofilm and do not remove it permanently from the mouth. We acknowledge that a change in the conditions—for example, through a drastic reduction in sugar consump- tion—would be very welcome, but difficult to implement in the long term in practice. We therefore ap- proach the structure of the biofilm and prevent its pathogenicity from developing. The solution is simple: we just have to regularly, that is every 24 hours, disrupt the struc- ture of the biofilm intensively on all surfaces of the tooth. Chemicals and medications don’t help a great deal, as the biofilm has very potent de- fence mechanisms. In your article, you spoke about lifelong dental coaching. What do you mean by that? Prevention is not just for children and young people. As caries and per- iodontitis are lifelong infections and decaying lesions, periodontal pock- ets, erosion, abrasions, trauma and dental infractions can arise at any age, lifelong prophylaxis is unavoid- able. This lifelong dental coaching is based on the preventative measures already mentioned, complemented by regular professional monitoring with high-tech diagnostics to catch symptoms in the subclinical stage, thereby allowing non-invasive ther- apy where needed. Therapy, diagnostics, preven- tion—what are your concrete recommendations? We cannot predict reliably enough how much of a risk a patient 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 prevention on the wrong tooth surface is there- fore very high. This applies to ero- sion, 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. How- ever, 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 nineteenth cen- tury. If one has the diagnostic oppor- tunity to recognise symptoms long before their clinical manifestation, such a concept suddenly becomes very interesting. We know that it takes years for clini- cally evident symptoms to develop in caries and periodontitis alike. If diagnostics are carried out with suf- ficient reliability and if diagnostic methods are available that catch symptoms in the subclinical stage, one will have enough time to tackle these with non-invasive methods. As dentists, we only tackle the symp- toms of caries with our restorative methods. For technical and practical reasons, we used to only treat symp- toms at a later stage, when the decay- ing lesions had already developed into cavities, because diagnostics weren’t as advanced and restorative therapy was based on macro-me- chanical principles. We needed the hole so that we had something to fill. Today, this concept hasn’t really changed in principle. From a profes- sional perspective, we are still treat- ing symptoms, but we have other diagnostic tools and therapies, so we don’t need macro-retentions for res- toration. This lets us act much earlier and use non-invasive therapies. Should we be concentrating on primary or secondary prophy- laxis? Individual primary prophylaxis is the foundation of everything, 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 pri- mary prophylaxis. 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-invasive 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 car- ies prophylaxis in your opin- ion? Individual home oral care by the pa- tient is the most important aspect for me. It might sound presumptu- ous, but many people can’t brush and don’t know which tools, prod- ucts 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 overseen by a dental professional. This profes- sional 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 practice 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 professionals, we have the knowledge to provide the correct diagnosis and to advise the patient on which tools, products and techniques would be the most effec- tive, quickest and cheapest for his or her individual circumstances. We can still get involved if professional therapy is needed and before clini- cally 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 vi- tal 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. Thank you very much for the interview. Editorial note: Prof. Krejci’s article, ti- tled “Lebenslanges ‘DentalCoaching’ anstelle ästhetischer Zahnmedizin” [lifelong dental coaching instead of aesthetic dentistry], was published in the January/February 2015 issue of Bayerisches Zahnärzteblatt. Emirates – Kenya outreach success By EDHC In August 2018, Emirates Dental Hygienists Club (EDHC) and Fair- care, an initiative by Goumbook, partnered to deploy a team of dental professionals and a general volunteer to Aitong in Kenya. The group was led by Rachael England, President of the EDHC. Faircare is a Dubai-based organisation that provides dental care to low income workers for just 10% of the usual cost, ensuring equitable access to quality dental care. England had previously visited Ai- tong in 2015, when she rendered a dental hygienist service and gave oral health lessons, while a team of dentists carried out basic restora- tive treatment and pain relieving extractions. This time, with the sup- port of an amazing team of 11 vol- unteers from four countries, they planned to go a step further and establish an ongoing service. Following one missed flight, two cancelled flights, a brief strug- gle to import 2000 toothbrushes and 2000 tubes of toothpaste and a bone shaking 6-hour bus ride, the team finally met in Aitong in Kenya, where they set up the mo- bile dental clinic within the village medical centre. Sterilisation and cross-infection can be an issue in developing countries when carrying out humanitarian work, but careful planning by Hi- lary Browne meant the team were well prepared with an entire decon- tamination process and two pres- sure cookers, ensuring both clini- cian and patient safety. A dental hygiene clinic was set up with two portable ultrasonic scalers and oral hygiene aids. Here, Hasna Hafsi, Yasmeen Arafsha, Hanan Abdalla and Dr Shaima Obaid Bin Rabeeha carried out dental screen- ings for the local school children, preventative treatment and proph- ylaxis scaling. Abdalla and Arafsha also held fun and interactive oral health lessons for groups of chil- dren, where they sang and learned about toothbrushing and healthy snacks. Patients often request cleaning to remove the brown Getting up close with elephants on the Maasai Mara stains seen frequently in the Mara, however this discolouration is due to the high levels of fluoride found in the ground water. Despite com- munity efforts, filters to remove such high concentrations are ex- pensive to maintain and following generations continue to be afflicted with severe fluorosis. triaged by dental hygienists Karina Carniato and Stephany Gardner who used their full skills sets to assess and anaesthetise patients ready for dental therapist Mada- lyne Tucker and dentist Dr Jamshed Tairie to carry out basic restorative care and extractions. Dr Tairie’s Back row L-R: Hilary Browne, Hasna Hafsi, Karina Carniato, Dr Jamshed Tairie, Zohra Tairie, Lisa Hicks. Front row L-R: Shaima Obaid bin Rabeeha, Yasmeen Arafsha, Hanan Abdalla, Stephany Gardner, Me (Rachael England), Maddie Tucker, Simi Senegey (local host) In the main surgery, patients were ÿPage 3