Lack of hygiene and too infrequent visits to the dentist are just two factors that make the teeth, gums and, consequently, the whole body ill. Smoking is a separate factor. In the case of smokers, the negative effect on the oral cavity is so great that it trumps all the others. Is the situation better for tobacco heaters and e-cigarettes? They will be checked by, among others scientists from the Medical University of Warsaw.
- Lack of care for the teeth results not only in caries and an unpleasant appearance, but also in many diseases
- There is a proven relationship between periodontal disease and diseases such as diabetes, heart attack, stroke and Alzheimer’s disease.
- In addition to the lack of hygiene, the most harmful factor for our teeth is cigarette smoking – argues Dr. n.med. Jan Kowalski, head of the mucosa and periodontitis department at the Medical University of Warsaw
- More information can be found on the Onet homepage
It has been said for years that Poles do not like dentists. We avoid clinics, we are afraid to visit them … Has anything changed in this matter for the better in recent years?
Dr hab. n.med. Jan Kowalski: There is indeed such fear. However, I think that the last decades have changed a lot in this matter. Today we have very effective anesthesia. It often happens that patients just fall asleep in our armchairs. On the one hand, it definitely has to do with a lot of relief – pressure and fear go down. But not only that. We now have, for example, a lot of procedures that are performed in the so-called rubber dam, i.e. instead of rollers soaked with saliva and other fluids, we use a special rubber. We use it to isolate a tooth or a group of teeth, thanks to which the procedure is performed outside the patient’s oral cavity. This improves comfort, there is no longer a risk of choking.
In addition, we also have anesthetic gels that can be used before injection, reducing this pain. The puncture itself is also only a minimal discomfort today, because we use needles to pierce the mucous membranes, not the subcutaneous ones. They are two, even three times thinner. And they are also sharp, which is especially important. Because it’s not about the thickness of the needle, but about its sharpness. When it is really hot, the sting is practically non-existent.
Do patients show that they change their minds once they are confronted with these news? Stressed people come, treatment takes place with the use of all these amenities and then they come back? Fear disappears?
It can be very different, because it all depends on the patient, the dentist and their mutual interaction. Unfortunately, despite all these amenities, there is still a group of patients who are afraid or have different priorities. They only come to us in intervention. Something happens and then they seek help. But there is also a large group, more and more numerous over the years, that comes to us as a check-up. This is what it should be like. We do not come to the office when something is already happening, but we make sure that everything is fine on a regular basis. This is the best path.
You told the doctor about your priorities. That we have other than teeth. Could you please tell me what happens, apart from the toothache itself, if we do not take proper care of oral hygiene, that is, when we have these other priorities?
There is a proven relationship between periodontal disease and systemic diseases. These include diabetes, cardiovascular diseases (especially acute coronary syndromes such as heart attacks and strokes), and there is growing evidence of a relationship between periodontal disease and Azheimer’s disease.
American research shows that the patient’s immune potential as a result of the diseases we endure in life is simply depleting. Colloquially, it can be compared to using a regular and sports car. When someone drives such a classic city car, acceleration or braking are less abrupt, so the engine wears out slower. In a sports car, on the other hand, the engine is constantly working hard. It is the same with the patient’s immune system, in whose body inflammatory processes take place all the time. Eventually something starts to happen and it can also be very serious diseases. Americans attribute almost everything to this mechanism, even cancer and rheumatoid diseases. And I have to say, although it will be very hard to prove that they might be right.
In addition to the lack of hygiene, I understand that there are also other factors or behaviors that negatively affect the condition of our teeth. So even if we scrub them thoroughly, even thread them, which we still have a problem with, I suspect that it does not guarantee us a healthy smile all the time. What else do we harm the oral cavity?
The most important such factor is cigarette smoking. It is so destructive that in the case of periodontal disease, when we conduct research on any topic, we must exclude smokers. This is because when they are turned on, the only thing that will come out in the results is that it is worse for smokers. And that obscures all other data. Unless we carry out a specific test on smokers, because we want to check something with them. Another factor is the broadly understood genetic factor. Periodontal diseases can, in a sense, be written in genes. Besides, diabetes, osteoporosis, obesity, age. Men have it worse because there is no protective effect of estrogen. And many other factors.
Alcohol? A child?
Alcohol may not be as bad, but diet may not. It’s about an unbalanced diet. Both high-sugar and high-protein diets are not conducive to dental health. Of course, nutritionists should be consulted here. There is certainly such a thing as a diet that benefits periodontium. It is a diet based on omega-3 fatty acids, polyunsaturated fatty acids, containing a lot of oxidants. A Mediterranean diet with fruits such as kiwi and cranberries is good for periodontitis.
Together with prof. Renata Górska conducts the international SMILE study. What are its main assumptions? What do we want to know?
From this study, we want to find out how switching from traditional cigarettes to non-flammable nicotine delivery systems reduces the adverse effects of tobacco. It must be said here that it is a treatment philosophy based on the concept of the lesser evil, i.e. harm reduction. We are aware that there is a group of people who smoke, smoke and will smoke. Nothing will affect it, because there is no administrative smoking ban. Nobody can forbid anyone to do so. In medicine, we often choose the lesser evil.
As part of the SMILE study, we want to see if the switch of smokers to e-cigarettes or tobacco heaters, these non-flammable nicotine delivery systems, will have a positive effect on the appearance of gums and teeth. We know from the scientific research to date that nicotine aerosols emitted by such devices have a different toxicological profile than cigarette smoke. They contain much less harmful compounds than cigarette smoke. We want to see how it affects the oral health of those smokers who will be qualified to the group using only one of such devices, which will replace them with smoking. E-cigarettes and tobacco heaters may be less harmful to periodontal tissues and the mouth than smoking, but we must be sure here and we want to verify this in research.
The main endpoint of the study is the measurement of the so-called MGI, or Modified Gingival Index. It’s a marker that describes gingivitis. Secondary points include tooth discoloration, the condition of the plaque and overall oral health. And there are already opportunities to investigate it objectively: we have photometers that measure the shade of the teeth or cameras that calculate the amount of bacterial plaque on the tooth.
The study is multi-center, coordinated by the center in Catania, by prof. Riccardo Polosa, a WHO expert in the field of chronic obstructive pulmonary disease. He invited our university to cooperate with us, but also universities from Italy, Great Britain, Moldova and Indonesia.
Who is eligible for such a study?
Traditional cigarette smokers only. During the qualification process, of course, we advise participants to give up smoking. Only if they do not consent to it, can they be included in the study.
At this stage, they are divided by the computer system into two groups: one will continue to smoke traditional cigarettes and the other will switch to e-cigarettes or tobacco warmers. Over the next few months, we will be comparing oral health parameters.
Participants will, of course, receive specialist care at all times, and if anything adverse to their health occurs, they will be immediately shut down – so that treatment can begin at the earliest possible stage.
Where should people interested in participating in the Polish part of the SMILE study go? What criteria must participants meet to participate in this study? How long will the examination take, when do we have time to submit the application?
As a rule, we invite all interested parties to us and we perform this qualification on site. We are located in the University Dentistry Center, in the Department of Periodontal and Mucosa Diseases in the same center. It is a newly built facility on the campus of the Medical University of Warsaw next to a pediatric hospital. Our address is ul. Binieckiego 6. In front of the building there is an internal, paid parking lot, where you can park your car and report to us.
Until when can you come for the examination? How long will it take?
The survey is open, we invite everyone interested to contact us. It lasts 18 months from its inception. Its beginning is not the qualifying visit, but the one with which we start the treatment. The patient finds out which group he is in, we perform a thorough tooth cleaning, detailed examination, measurement of the shade of the teeth, and the amount of plaque. The patient installs a special application to contact us, to report any adverse effects, if they occur, to remind them of appointments with us. This application is specially designed for the sole purpose of this study. What I didn’t say, and this is important in the context of dentophobia: these tests are completely non-invasive and not accompanied by even the slightest discomfort.
When can we expect the results?
Two to four years, I think, until it is published in one of the scientific journals. Although sooner, probably after about two years, the preprint should have appeared.
Contact:
Dr hab. n.with Jan Kowalski, tel. 502 171 285. Mail: [email protected]