Dental flossing – what can be more boring? But we do it every day, and we believe ourselves to have done enough to prevent caries. However, the significance of this routine becomes much clearer when you learn that bleeding gums, or untreated periodontitis, can lead to many more serious issues.
The chief physician at the Swissparc dental clinic in Zurich, Michael Meier MD, knows all about the results of neglect in oral hygiene and is attentive to every detail. It is no coincidence that the patients of this world-recognized dental art virtuoso include top VIPs and politicians…
– Dr. Meier, in theory, everyone knows how to take care of their teeth. But in practice, it turns out that we are not doing enough. What do you think is particularly important?
– The most important thing is to instill good habits during childhood. A child should be taught to brush his teeth, even if he does not want to. He should be taught not to eat too much sugar or drink carbonated beverages. After all, these small things will later affect their health. Swiss schools even provide special lessons on dental health – a Dental Assistant who is trained in prophylaxis comes and explains how to brush one’s teeth properly. At the age of 6-7, the milk teeth fall out and the first molars (the sixth) emerge, which will remain for the rest of the child’s life. So this is the right time to start visiting a dentist regularly, to monitor the proper development and growth of the child’s teeth.
Adults should also not neglect their dental routine. They need to visit a hygienist, if you have healthy teeth and no cavities, who will remove plaque and tartar beneath the gums which can lead to prophylaxis, at least once a year. It is important to develop a healthy environment in the oral cavity. You should take care that the spaces between the teeth stay clean and thus do not become an environment in which bacteria will be allowed to multiply. This is especially important for those who wear implants. Some people think: well, my tooth has been removed and I have an implant, I have no need to worry about anything anymore. That’s a mistake. Inflammation can occur around an implant, and this is more difficult to treat than a natural tooth. Therefore, one should take care of implants properly, and visit the dentist twice a year.
– And crowns need special care, too?
– Yes, those who have a crown or a dental bridge installed should pay special attention to them. It is better to use a sonicare tooth brush (electronic and vibration) and a special brush to clean in between the teeth.
– And dental floss is not enough?
– It is difficult to clean in such places with floss. In addition, if you use floss improperly you can dig too deep into the gum and cause damage. In this sense, the interdental brush is more reliable, as it reaches well into the gap between the teeth and cleans them thoroughly. It is also important to treat the space around the crown or implant, as the distance between them and the other teeth keeps changing. It is better to get advice beforehand from a dentist who will help you choose a suitable brush and show you the right brushing technique.
Electric toothbrushes are very efficient, with vibrating head moving (appr 40’000 vibration per minute) and also pulsating simultaneously (from 20,000 to 40,000 pulsations per minute). Pulsations allow the bristles to better penetrate the interdental spaces, as well as to loosen plaque. If the brush has a sound (or ultrasound) effect in addition to the mechanical function, it significantly increases its efficiency.
– If we see blood whilst brushing, does it mean that the gums are unhealthy?
– Yes, it is a sign that they are unhealthy and that you need to visit the dentist:
your toothbrush may not be suitable for your teeth, and you may need to buy another, or there may be an inflammation somewhere.
The teeth that are hard to reach can form so- called “pockets”:they accumulate bacteria, causing inflammation. This could have far-reaching consequences, since an unhealthy oral cavity is a direct path for bacteria to get into the blood. To date, there have been serious scientific studies that confirm that oral diseases increase the risk of myocardial infraction and strokes. Harmful bacteria that multiply in the mouth are quite aggressive: they cause chronic inflammations and move on through the blood vessels to other bodily organs, including the heart. Over the last 10 years the attitude to oral health has become much more serious – it has a big effect on one’s general bodily condition.
– It sounds scary. Can you describe these studies in more detail?
– They have been carried out in different countries. For example, the National Health and Nutrition Examination Survey I (NHANES I) organization has established a clear link between poor oral health and chronic lung disease. Oral health indicators were poor in people who had lung problems (the gum conditions and dental plaque were estimated, considering such factors as age, sex, smoking, etc). According to these studies, people with a low oral health index have a 4.5 times higher risk of developing lung disease
These findings have been confirmed by Chinese researchers, who have established a link between lung disease and chronic periodontitis. They postulate that expert periodontal therapy improves the condition of the lungs and reduces the frequency of exacerbations of the disease.
Several studies have shown a relation between diabetes and oral lesions. In the United States, with 25.8 million diabetics (8.3 percent of the population), the causes and the methods of treatment are being seriously studied. One third of patients younger than 30 who visited the dentist and whose teeth were treated have dysglycemia (a pre-diabetic change in blood sugar levels).
The President of the Swiss Society of Periodontics, Anton Skulean, has published official data that indicates that oral bacterial infection, as well as periodontitis, is one of the causes of infarction.
The list of diseases that are associated with oral infections is constantly being updated, and many specialists also include Alzheimer’s disease, impotence, cancer, and other diseases on the list. This has been the subject of many studies and many assumptions have now been confirmed. So we cannot neglect periodic visits to the dentist.
– Can your clinic perform analyses on the presence of bacteria that cause these diseases?
– It is not necessary, as a clinical examination allows for an immediate diagnosis. An exam by an experienced dentist is all that is needed. He will check the oral cavity for the presence of so-called pockets, will identify early warning signs and will take the necessary measures.
– Sometimes the teeth seem to be healthy, but they react to hot or cold substances with an unpleasant sensation.
– This increased sensitivity can be explained by over-vigorous brushing of the teeth. Today, we have a variety of tools that allow you to deal with this problem. But in this case the dentist will most likely recommend that you change from a manual toothbrush to an electric one, which cleans more gently but more effectively.
– We have discussed toothbrushes, but how does one choose the right toothpaste?
– Of course, it is best to follow the recommendations of a hygienist who will help you to make the right choice depending on the condition of your teeth and on your food habits, as the paste should be strong enough, but not too aggressive. The Relative Dentin Abrasivity (RDA) level should be no higher than 50. There are also whitening toothpastes, which efficiently remove plaque. But if you have sensitive teeth, you should choose a different product, as there is now a wide range available from different manufacturers.
– The debate is ongoing about whether toothpastes with calcium are beneficial or harmful. Some experts believe that we are already getting more than enough calcium – do you agree?
– A lack or excess of fluorine is much more important. This trace mineral, along with calcium, potassium, magnesium, and others, is involved in the physiological processes of the body. The greatest amount of fluorine is stored in the teeth and bone tissue. A lack of fluoride leads to caries and an excess to the development of so-called fluorosis. Together, fluorine, phosphorus, and calcium strengthen the surface of the teeth, with the active participation of saliva, so more attention should be paid to fluorine – that’s why many toothpastes and dental care products contain this element.
Fluorine enters the body mainly by way of water, which is why they saturated drinking water with it in earlier decades. But now we know about the negative influences of it and the possibility of overdosing, and the level of fluoride in water is now monitored.
As for calcium, it is better to get it in several ways. If it has entered your stomach, it does not mean that the right amount will reach your teeth. It is particularly important to monitor micronutrients in children, as a sufficient amount in the body will later influence the formation of the teeth.
– That is to say, a cup of milk before bedtime is a good habit to get into?
– Yes, but if the child has a habit of drinking milk before bed and is not accustomed to brushing his teeth afterwards, the risk of oral diseases is increased. Milk contains lactose, which is retained in the mouth and which creates favorable conditions for bacteria. Also important is the excessive consumption of carbonated drinks, which are very high in sugar.
Michael Meier
is a Doctor of Medical Sciences and a dentist at the Swissparc Clinic. In 2002, he graduated from the University of Zurich. From 2002 to 2006, he had a private practice at Dr. Urs Schellenberg’s dental centre in Zurich. From 2004 to 2006, he worked in the department of mastication disorders at the Dental Centre in Zurich. From 2006 to 2011, he worked as a private dentist at the Swiss Smile Dentist Center in Zurich. He is a founder of the first children’s emergency clinic in Zurich (2011). Since 2011, he has been working in a private practice at the health centre of Grand Resort Bad Ragaz (the dental practice Perfect Smile Ragaz GmbH). He is also the author of many scientific articles and publications.
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