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Take the hint



Dental diseases are not immediately apparent merely from toothache and pain. Do you see blood during brushing? Well, few people bother to go to their dentist as a result of such a seemingly trivial detail. Meanwhile, the teeth deteriorate, and only a specialist can help. One of Switzerland’s leading dentists, Michael Mayer, is sure that there are no ‘trivial details’ in dentistry, and asserts that small issues that could be easily remedied if attended to in time result in serious problems if ignored. He talks about this, and why the hygienist is a separate specialist in Switzerland, in this interview with SHM.

– Dr. Mayer, almost everyone sees blood on their brush while brushing. There is usually no pain nor any other alarm signals. Is this a serious symptom? Is it necessary to visit a dentist immediately?

– Usually, the appearance of blood during brushing is the first sign of inflammation. There is no pain, nothing else to be bothered about, and so a person simply forgets about it. But bleeding should never be ignored. It indicates that the gums are not healthy! It may be a sign of periodontitis or its initial stage, gingivitis.

Periodontitis is a disease of the tooth and the tissues around it. Over time, the inflammatory process spreads to the bone tissue. Loss of teeth in older people is very often caused by this.

– What are the causes of periodontitis?

– It’s quite simple. The problem arises when you brush your teeth with an unsuitable brush, or do not clean the interdental spaces, or do not do so carefully. The disease can be cured completely at its initial stage. If it is allowed to advance, eventually the diseased gum starts to rise, exposing the base of the tooth, the bone, and the ligaments. Periodontitis takes a chronic form, and it will not be possible to completely get rid of it. The affected tissues will not regenerate.

– How do you make a diagnosis?

– The dentist makes a diagnosis during a general examination, while examining the space between the gums and the tooth. In the presence of a periodontal pocket, one checks for bleeding and measures the depth. If it is more than 3 millimeters, this is a sign of periodontitis.

In order to spot the first symptoms of inflammation, I recommend a penetrative examination to my patients. You pass a special interdental brush between the teeth, wait a few minutes and examine the part of the gums where the blood came out in the mirror.

This method is good because it allows you to monitor the condition of the gums yourself. In addition, it motivates the patient to follow all the dentist’s instructions. The patient sees that there is less blood each time, which inspires them to continue until, one day, the brush comes out absolutely clean.

So, if periodontitis has started to develop then you must visit a hygienist, who will confirm the diagnosis and develop a treatment regimen.

– And is it necessary to visit a hygienist if you have a preventative intention – for example, for the hygienic processing of an oral cavity?

– Of course. After all, the hygienist removes tartar and plaque, making the surface of the tooth soft. In general, he/she takes the necessary measures to prevent infection.

There is a unique system for the training of dental hygienists in Switzerland. A general dentist here takes two courses of basic medicine and three courses of specialization at university, then he/she receives a dental diploma. To become a hygienist, you need to study for three additional years. But if you follow a hygienist’s advice your outgoings on dental treatment will decrease, because the hygienist’s task is to prevent not only periodontitis but also tooth caries.

– And what to do if bleeding starts and stops?

– When bleeding is observed for several days in a row, this is a serious sign. One needs to take action. Perhaps it will be enough just to change the technique of cleaning your teeth, and to start doing it the right way.

The hygienist will instruct you on how to clean the spaces between the teeth. There are areas that you do not get at with an ordinary brush – you need a special interdental one. And you can practice oral hygiene at any time – for example, while driving a car or watching TV. The process does not take much time.



– Is it possible to buy interdental brushes in Russia?

– Oh, sure. There are two types of these brushes. But it is important that the hygienist teaches you how to use it properly, and gives you recommendations on the size of the brush you need to buy – if it is too narrow, it will not be possible to clean the teeth well, but if it is too wide it will damage the gums.

In fact, the idea is to brush your teeth three times a day, but it’s enough to use an interdental brush every morning and evening, and toothpicks in the afternoon.

– How quickly does inflammation develop?

– I would say swiftly. The disease can develop as far as the chronic stage in less than a year.

– And what to do when a diagnosis of periodontitis has already been made?

– This means that you are ready for long-term treatment. The hygienist will gently clean the teeth’s surfaces, because they will have become soft under the influence of the bacteria. The general treatment regimen is thus: two treatment sessions with a break of a week. After a month there is a check-up, and then a second one three months later. Over the next two years, the patient must plan a visit to the dentist every three months until the disease goes into remission. Affected bone tissue cannot be completely restored, but it is possible to reduce lesion depth.

The treatment of periodontitis always involves an individual program which the hygienist develops while taking into account the individual characteristics of the patient – the jaw structure, the tooth location, etc. In some cases, the dentist analyzes the composition of bacteria by taking a sample and sending it to the laboratory. Some antibiotics might be prescribed, depending on the results of the analysis. But such an analysis is needed only in about one out of twenty cases.

In particularly difficult cases, when hygiene procedures are not effective, you can resort to surgery. The doctor exposes the tooth’s surface to the root, inspects and cleans the periodontal pocket, and then seals it. Complacency often leads to this situation – many people are simply afraid to visit a doctor. And in the end, they come to us with a disease in its advanced stages.

The infection that caused the inflammation will gradually move into the bone, and over time, you will feel your teeth begin to go crooked. Then there will be pain.

To avoid this, I advise that you have hygienic dental treatment twice a year. Yes, sometimes it can be a sensitive procedure, if the doctor is conscientious. Light stroking will not work. Gum health must be monitored every second year, and the dentist must be visited annually for a general examination, if there are no specific problems.

– So it turns out that what might seem a minor symptom, at first, can have serious consequences?

– Yes, and there are several consequences. For example, implantation is not possible in the case of periodontitis: bacteria can penetrate the circumcision tissue and prevent healing, or cause gum inflammation at the site of installation. Therefore, the implant can be installed only on a sound basis.

Dental health care is a very important thing for the health of all body. If you teach your children to brush their teeth properly from an early age, it is unlikely that they will have problems with tooth decay. However, the slightest infection can spread. Bacteria in the periodontal pockets can quickly enter the bloodstream and spread throughout the body. Then they can settle in different organs and cause numerous diseases, so healthy gums are an important factor for the whole body’s health. They create a barrier and prevent bacteria from entering.



Michael Meier

MD, Doctor of Dental Sciences. Graduated from the Department of Medicine at the University of Zurich in 1998, after which he worked for one year in the Department of General Internal Medicine at the Hospital of Zug Canton, and for approximately three years as a research fellow at the University of Zurich’s Institute of Forensic Medicine. From 2002 to 2006 he worked as a doctor’s assistant at the Zurich Dental Center, then in 2006 he began to work independently at a private dental practice. In 2011 he became one of the founders of the KinderPermanence by Swiss Medi Kids Zurich AG pediatric center. He also owns the Perfect Smile Ragaz GmbH dental clinic in the Grand Resort Bad Ragaz Medical Centre.

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