IN DEPTH PREVENTION TREATMENTS INTERVIEW DID YOU KNOW? REPORT Why is Mouth rinses: All you ever “A person cannot 10 myths The “litmus interdental questions and wanted to be considered about oral test” of oral cleaning so answers know about healthy if health to hygiene they have a important? orthodontics periodontal demolish but were disease” afraid to ask Dr Adrián Guerrero, 4 10 18 president of SEPA 20 24 26 13 Educational magazine No. 13. of the SEPA Foundation 2nd semester 2017 of Periodontology Editor: Héctor J. Rodríguez and Dental Implants Get fit, take care of your gums Periodontology for everyone
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Gold: 03 SUMMARY PRESENTATION
Héctor J. Rodríguez Scientific editor of the magazine Preview: Take Care of Your Gums IN DEPTH Get fit, take care More oral hygiene, of your gums 4 fewer sugary drinks WE LIVE IN A SOCIETY MARKED by the Sport is health if it is practised in an appropriate and increase in obesity, the growth in cases responsible way. Within these good habits it is also of diabetes, and a surge in cardiovascular essential to take care of oral health. Furthermore, it is diseases. In the face of this, it is ever more known that a diseased mouth produces a situation of necessary to promote healthy lifestyle chronic infection that can cause muscular problems, habits. There is a growing number of Apps tendonitis, arthritis… which will limit an athlete’s that allow us to know if we are performing performance. exercise correctly and doctors are working to recommend simple practices of physical exercise to their patients, accompanied by dietary advice. All this with the aim that the PREVENTION DID YOU KNOW population enjoys a better quality of life. THAT...? Mouth washes: 10 We assume that practising sports allows questions and Demolishing 24 us to enjoy better health, but people are answers 10 myths unaware that there is a relationship between about oral sports performance and oral health. A survey health carried out by University College London, co- ordinated by Ian Needleman of the Centre for Oral Health and Performance (www.ucl.ac.uk/ PREVENTION REPORT cohp) – and carried out within the framework of the 2012 Olympic Games in London – How to stop 14 The “litmus 26 found that 18% of athletes recognised that smoking test” of oral their deficient oral health had a negative from the hygiene dental impact on their sports performance and that surgery? 46.5% said that they had not been to the dentist within the previous year. Simple strategies to prevent problems of oral health can offer marginal performance TREATMENTS OUTREACH gains that require little or no additional time All you ever 18 Everyone with 30 or cost. wanted to the Alliance The intense dietary pressures and training know about for Periodontal of professional athletes increases their risk orthodontics and General of suffering oral problems. Sportsmen and but were Health sportswomen need energy for training, which afraid to ask means that the consumptions of diets high in carbohydrates and the ingestion of many sugary drinks is common; however, the acids INTERVIEW UPDATE produced by these habits can contribute to Dr. Adrián 20 Higher risk 36 dental decomposition and erosion. Guerrero, of cancer But it is not only a problem for professional president of of the athletes: anyone of us can develop oral the Spanish oesophagus diseases if we do not follow certain minimal Society of with diseased precautions and abuse sugary drinks. Periodontology gums (SEPA)
Take Care of Your Gums SEPA Foundation Trust: Trustees: Editorial Committee Project Management For more information: Informative publication of Executive committee trustees: David Herrera, Antonio Liñares, Take Care of Your Gums: and Communications team: Tel.: 913 142 715 the SEPA Foundation of President: Blas Noguerol, Editor: Management: Javier García www.cuidatusencias.es Héctor J. Rodríguez Casanovas www.sepa.es Periodontology and Dental Adrián Guerrero Mariano Sanz, Mónica Vicario, Co-ordination: Laura Demaría Vice-president: Ion Zabalegui Section co-ordinators: Writing: Francisco Romero [email protected] Implants. AntonioBujaldón Juan Puchades, Gloria Calsina, Honorary Trustees: Editing: Emma Pérez Nerea Sánchez, Assumpta Carrasquer, Edited by: the SEPA Secretary: Jan Lindhe, Niklaus Lang, Technical co-ordination: EvaCastro Rosa Puigmal, Olalla Argibay, Mónica Foundation of Periodontology José Nart Raúl Caffesse, José Javier Editorial design: Juan Aís Muñoz, Cristina Serrano, Desirée Abellán. and Dental Implants. Spokespeople: Óscar González, Echeverría, Juan Blanco, Printing and layout: Co-ordinator: Regina Izquierdo Regina Izquierdo, Nuria Vallcorba elEstudio.com PaulaMatesanz, Legal deposit: Francisco Vijande M-21249-2011 04 - 05 IN DEPTH Having a healthy mouth helps improve sports COLABORA: performance and the reverse is also true, as appropriate sports practice can have beneficial effects on oral health. Get fit, take care of your gums
SECTION CO-ORDINATED BY: IN RECENT YEARS, and on the basis Oral care forms an Juan Puchades Rufino of the greater understanding of the essential part of the Associate Professor systemic effects played by the health of healthy habits that any of Periodontology the gums on general health, there has at the University of Valencia been growing interest in investigating sportsman or sportswoman and understanding better the links should adopt between sports performance and periodontal health. Carrying out sports implies an effort on Although much more is known about the part of the organism, even more so the relationship between key aspects when an elite sportsman or sportswoman of physical exercise and the is concerned. Because of this, the inflammation that characterises gum organism must be at an optimal level to diseases (and which spreads to other develop properly. As a part of our body, parts of the organism, a process known the mouth must enjoy a good health to be as systemic inflammation). able to allow the organism to cope with strong physical demands. Sport is health … including oral health Bite into your sports The Spanish Society of Periodontology performance (SEPA) and the Spanish Society of Sports And it has been demonstrated that Medicine (SEMED) have collaborated problems originating in the mouth can in the writing of a report entitled cause a reduction in sports performance. “Periodontal health, sports, and quality It has been seen that the severity of of life”, where – among many other the periodontal disease is related directly things – certain current and relevant to the reduction of muscular strength in aspects of periodontal health and sports flexing the arms, in the abdomen, and in practice are highlighted. Sport is healthy running, and that more advanced forms if it is practised in an appropriate and of periodontitis are associated with the responsible way, forming part of a healthy reduction of cardio-respiratory capacity. lifestyle. And within these habits oral There is an important biological health is essential. basis that determines this connection www.cuidatusencias.es
What happens when we train? PHYSICAL EXERCISE generates an increase in our metabolism,1 that is to say, it provokes an increase of changes and reactions in basic cells of the organism. Specifically, it implies a greater expense in the aerobic metabolism2 and a greater consumption of oxygen. This gives rise to the generation of a large quantity of oxygen free radicals, molecules that activate the antioxidant capacity of the cells and which are responsible for protecting the cellular structures that generate energy (the mitochondria), thereby enabling a good sports performance. However, in the most intense and sustained efforts, this production of free radicals overcomes the antioxidant mechanisms, and can generate oxidative damage. If the stress that is induced in the organism is maintained over time, it reduces the capacity to produce energy. At the muscular level, the repetition of sports movements provokes micro-cracks, which generate a local inflammatory response which, when moderate, stimulates the development of the musculature. However, if those actions are exaggerated, they combine with oxidative damage and are maintained over time, they produce a generalised inflammatory process that manifests with a reduction in sports performance. This is what is known as the over- training syndrome. If the sportsman or sportswoman reaches this point, a series of generalised inflammatory processes are generated and there is a reduction in the organism’s defences, which interferes with the production of energy and the body’s capacity for recovery. These inflammatory processes that can be produced by overexertion can also derive from other sources of inflammation, such as infections of the mouth and, in particular, gum diseases. 06 - 07 IN DEPTH
Elite athletes: failure in oral health
CONTRARY TO THE PERCEPTION that and 15% sports players enjoy good general health, periodontitis. many studies carried out involving elite In addition, athletes show that a high percentage 40% were of them have oral health that could be worried improved. about their A study carried out at the Eastman Dental oral-health Hospital in London evaluated the oral health problems, of Olympic athletes and professional football 28% said and basketball players. Some 8% of them that these recognised that oral problems affected their problems training and 5% that it affected their sports would have performance. While 15% of the sportsmen repercussions and sportswomen presented irreversible on their gum disease, 76% had gingivitis. The most quality of life common mouth problems in these athletes and 18% that they would affect their sports were dental trauma, caries, gum diseases, performance. dental erosion, and inflammation around There are also examples in Spain. A study wisdom teeth. carried out on Barcelona football club The same researchers had previously carried professional footballers showed that a out an evaluation of the oral health of 278 higher degree of periodontal compromise athletes during the London Olympic Games and poorer levels of oral hygiene were most in 2012, detecting that 55% had dental often correlated with muscular injuries. caries, 45% dental erosion, 76% gingivitis,
“Athletes must be aware Dr. Carlos de Teresa of the importance that Member of the governing THE oral health has in their board of SEMED OPINION sports performance” Institute of Nutrition OF THE EXPERTS and Technology of food products (INYTA) University of Granada. www.cuidatusencias.es
The Achilles heel of athletes’ oral health
Among the causes of deficient Nutritional Alteration of Little Lack of oral health among elite 1 problems: 2 immunological 3 knowledge 4 adoption sportsmen and sportswomen, frequent mechanisms about oral health of effective the following stand out: consumption of through and common prevention carbohydrates dehydration, harmful habits measures and very acidic dry mouth, and energy drinks intensive training
between periodontal health and sports A good oral state decreases It has also been shown that people performance. One of the main causes of the risk of injuries and of who carry out more sport in their free the reduction of sports performance in certain diseases and, in this time present fewer inflammatory markers people with poor oral health results from way, contributes to sports than those who do not, which allows the presence of systemic inflammation, us to think that sports activity could “which affects the production of energy performance offer protection against an excessive by muscles, resistance, muscular inflammatory response in periodontitis. strength, and the neuromuscular be related to pains in the neck and back, The possible relationship between co-ordination upon which the precision and poor mastication can provoke the obesity, good physical health, and of sports motions depends,” states lessening of an athlete’s energetic power. periodontitis has also been analysed, Dr Carlos de Teresa, professor of In the end, a correct oral status reduces showing that people with lower body the Department of Physiology at the the risk of suffering injuries and certain mass indices and higher consumption University of Granada. diseases and, in this way, aids sports of oxygen during physical exercise have In a diseased mouth, a situation of performance. better periodontal health. chronic infection is produced that can And obesity has been shown to be a lead to muscular problems, tendonitis, Sport positively affects risk factor for suffering periodontitis. arthritis… which will limit an athlete’s your oral health It is therefore suggested that people performance, above all when they are Although gum problems can reduce sports who practise sport habitually and who also associated with pain and functional performance, it has also been shown that present a correct body mass index could limitation. Chronic infection is also correctly performed physical exercise has have less risk of suffering periodontitis. linked with greater muscular fatigue and great benefits for our organism’s general It is therefore suggested that people who a slower recovery from muscular injuries. health, including the mouth. practise sport habitually and who present Equally, specific oral problems tend In recent years an increasing number a correct body mass index could have less to be associated with disorders that can of studies have shown, for example, that risk of suffering periodontitis. minimize sports performance; thus, for poorer periodontal health is related to a example, a malocclusion3 can produce a reduction in aerobic capacity, in balance, defect in balance, tension in the jaw can and in the speed of the feet.
“Periodontitis, like Dr. Antonio Liñares inflammatory disease, can Periodontist and Trustee reduce the contractibility of SEPA Foundation. of muscles and cause the sports player to have more muscular injuries” 08 - 09 IN DEPTH
THE OPINION OF THE EXPERTS Take note: practical advice
“Oral diseases are common in athletes and can prejudice their sports performance, but they can be prevented with simple and low-cost interventions”
If you start physical If you practise sport activity regularly
Before starting any regular physical activity, Sport must be adapted to the level of Prof. Ian G. Needleman 1 it is very important to have a proper medical 1 physical condition. Sports carried out at high Centre for Oral Health check-up so that health professionals can detect intensity and in a prolonged form can increase and Performance (COHP). any possible risk for your general and oral health, inflammation and the risk of suffering oral disease London (United Kingdom). analysing absolute contraindications and those and sports lesions if not correctly regulated. relative to sport. It is recommended to explore In these cases, specialist advice in relation to any cardiovascular or metabolic risk related to the the type of sports activity and its intensity is metabolic syndrome. recommended.
Remember the importance of a balanced diet In the oral cavity, sportsmen and 2 for improving the health of your month, and 2 sportswomen present a higher risk of: “The health of your for adapting the body progressively to physical a) Dryness of the mouth, in exercises of mouth is the mirror effort (muscular-skeletal, cardiovascular, and greater intensity and duration, which of your sports health” metabolic development). modifies the saliva (becoming more acidic), increasing the risk of infections It is very important to maintain good oral such as caries. 3 hygiene and, if there are missing teeth, it b) The intake of sugary drinks and is necessary to evaluate if there is an adequate compounds during sport, in the form masticatory function that allows food to be of gels, sugary drinks…. and which, in chewed properly. Pay special attention to the conditions of dryness in the oral mucosa, evaluation of gingival health,4 carrying out the can provoke dental damage. necessary actions and functional rehabilitation if c) Hyposalivation in high-intensity sports. necessary. Dra. Araceli Boraita All this contributes to a potential risk of greater oral problems. Because of this, a greater and JHead of the Cardiology It is also advisable to detect the presence of 3 stricter oral control of habitual sports participants Service. Centre for Sports caries and resolve them. Medicine. Department 4 is recommended, and it is advisable to balance the for Sport and Medicine. diet (carbohydrates, proteins, and vitamins) and Spanish Agency for the hydration according to the needs of the sport. Protection of Health in Sport.
“When a dentist looks Dr. Blas Noguerol after the periodontal Periodontist and health of a sportsman or ex-president of the sportswoman, he or she Spanish Society of is also contributing to Periodontology (SEPA). improving their sports performance” www.cuidatusencias.es Take note: practical advice
Before carrying out amateur Dr Blas Noguerol, specialist in or professional sport, it is periodontology and implantology, important to know the state stresses that among the most important of your oral health pieces of advice that can be offered to athletes, “before considering the amateur of professional performance Expert of any sports, it is necessary to know recommendations the state of your oral health.” Such care, Despite all this, people do not generally he points out, “must be carried out in a consider that a person who practises team: between the dentists, the sports sport professionally can suffer from a doctor, and the general practitioner”. health problem. “It is paradoxical to In this area the dentist, as Dr If you have had or have verify how in most elite sports a high Izquierdo recognises, “plays an essential degree of professionalisation has been role in promoting physical exercise and problems with your gums installed and an exhaustive planning improved nutrition, as the basis for of the smallest detail that can affect preventing periodontitis and optimising A balanced diet rich in anti-oxidants, polyunsaturated performance, but care of the oral oral care”. 1 fats, and Omega-3 protects against periodontitis. health of sportsmen and sportswomen In the words of Dr Noguerol, this The correct intake of carbohydrates and proteins continues to be underrated and ignored,” professional is required “not to be 2 facilitates the assimilation of exercise, reducing says Dr Regina Izquierdo, a periodontist satisfied with strict oral care but also the risk related to periodontitis. and SEPA spokesperson. She adds that to be involved in the vision of the “if athletes were subjected to routine patient as a whole, in which it is not 5 Regular aerobic exercise improves the response dental check-ups they would be able possible to separate oral care as a 3 and adaption to stress and inflammation, to avoid and control in a simple and self-contained area”. protecting against periodontitis. effective way some of the injuries Recuperative sleep is very important to produced in practising sports”. 4 assimilate physical stress and reduce the According to Dr Pedro Manonelles, negative effects that increase the risk of presenting president of SEMED, “Providing regular oral and physical disorders. check-ups and correct education in oral hygiene is basic for sportsmen and If you are a senior sportswomen”. sportsman or sportswoman GLOSSARY Regular exercise, balanced diet, and rest slow the ageing process. 1. Metabolism: set of physical and chemical 5. Aerobic exercise: the development of 1 processes and reactions to which a cell is activities with lower intensity than those 6 Treatment of edentulism (absence of teeth) is subjected. carried out in anaerobic exercise, but 2 key to maintaining general health and quality of 2. Aerobic metabolism: cellular process during longer periods of time (walking, life at this age. through which the body uses oxygen with running, swimming, and cycling), with the aim of achieving greater resistance. Improving strength and resistance, through the the aim of producing energy. 6. Edentulism: total or partial absence or practice of exercises such as rapid walking, reduces 3. Malocclusion: incorrect alignment of the 3 loss of teeth. the risk of death and can reduce the risk of heart diseases. teeth. 4. Gingival health: health of the gums.
“Good oral Dr. Pedro Manonelles healthcare is President of the Spanish essential for Society for Sports Medicine high sports (SEMED-FEMEDE). performance” Extraordinary professor of Sports Medicine at the San Antonio Catholic University, Murcia (UCAM). 10 - 11 PREVENTION
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Mouth washes have become a widely used resource in oral hygiene, but they are not always used correctly. Mouth For this reason, it is important to know why and when to use them, and washes: which ones to use. questions and answers
SECTION CO-ORDINATED BY: Why should we use The wide range of mouth washes disabilities that prevent them from Gloria Calsina mouth washes? encourages patients to ask advice in the performing correct oral hygiene Certified in periodontology TO PERFORM PROPER oral hygiene, dental clinic to choose the most suitable 2) As support for mechanical oral University of Southern able to efficiently remove dental plaque,1 one, as they do not require a medical hygiene: California. USA mechanical methods2 are not always prescription. • In periodontal patients: after root scaling,5 sufficient. Problems of compliance and in people with aggressive periodontitis the difficulties involved in some oral- When should antiseptic together with the use of antibiotics and hygiene techniques – above all at the mouth washes be used? during periodontal maintenance, if good interdental level – lie behind this deficit. Mouth washes are not always indicated oral hygiene is not achieved As a result, the help of other resources for all types of people. Generally, they are • In patients who are medically is needed such as the use of anti-plaque/ recommended when patients are not able compromised and immunosuppressed, anti-gingivitis mouth washes, easy to use to brush their teeth or to reinforce tooth- predisposed to oral infections such as by patients. Mouth washes should be used brushing: candidiasis correctly, and following the indications on 1) They can serve as substitutes for • In people with halitosis the product (number of rinses, time, and brushing or interdental cleaning when • In people who are receiving orthodontic dosage) and of the dentist who prescribes these methods cannot be carried out in a treatment with poor control of bacterial them, in order to achieve the beneficial temporary or permanent way: plaque effect and avoid side-effects. • After oral, periodontal, or orthognathic3 • To prevent caries in patients at high risk Mouth washes should never be used surgery of the jaw (during cicatrisation) of suffering from them as a substitute for dental and interdental • In acute oral gingival infections,4 when • In patients with xerostomia (dry mouth), brushing, but as an auxiliary aid, above pain prevents correct oral hygiene to reduce candida and plaque, and to all in the areas that are difficult to reach • In patients with physical or mental increase the flow of saliva (rear zones, the tongue, and in patients who lack dexterity). One can now choose between many Antiseptic mouth washes types of mouth rinse that are available in the market, depending on the needs of have anti-plaque and anti-gingivitis each person and the recommendation of their dentist. activity www.cuidatusencias.es
“Mouth washes are an Dr. Jorge Serrano ideal complement to Collaborating professor, THE brushing teeth in the Master’s degree OPINION in Periodontology, OF THE prevention and treatment EXPERTS of many oral diseases” Complutense University of Madrid. 12 - 13 PREVENTION 5 ideal properties
• In patients with mouth ulcers Its use should be indicated by the Mouth washes should be • In patients with partially removable dentist and should not be prolonged for used to tackle different prothesis lengthy periods of time. dental problems • In patients with dental implants Once used, the CHX remains active in the mouth for up to 12 hours. The patient Why do we use them? must wait half an hour between brushing Essential oils Mouth washes can be used to tackle teeth and mouth-rinsing, as many of the Essential oils can be a good option in various dental problems: to combat mouth ingredients in toothpastes can reduce its the long term because they have fewer infections (antiseptic), to prevent the anti-bacterial effect. This complicates the side-effects than chlorhexidine. However, appearance of dental caries, to treat dental correct use of the product. because of the high alcohol content in sensitivity, to treat halitosis (bad oral some of them, their taste can be strong and smell), and to treat xerostomia Mouth washes should be this can restrict their use by patients. They (dry mouth). used correctly and following are used as a combination of essential oils: the instructions of the eucalyptus, menthol, methyl salicylate, Which ones to use? product and the dentist who and thymol. They can provoke a burning prescribes it sensation and, on occasions, staining, ANTISEPTIC MOUTH WASHES but they do not produce changes in taste These have anti-plaque and anti-gingivitis Chlorhexidine has an anti-plaque effect perception nor an increase in the forming activity. Used as a support for the of 33% and an anti-gingivitis effect of of tartar. They can irritate the mucosa if treatment of periodontal disease. 26% and acts against bacteria, fungi, and not used correctly. viruses. There is another group of mouth Clorhexidine (CHX) washes designed to maintain the general Triclosan The one most commonly used for the health of the mouth, thanks to their Mouth washes with triclosan have an treatment of inflamed gums. It is the composition with disinfectant agents that anti-plaque and anti-gingivitis effect. best and most efficient anti-plaque and can be used on a daily basis and do not They should be combined with anti-gingivitis agent, but its use on a present side-effects or staining. copolymers and/or zinc to reinforce daily and continual basis cannot be They are useful in periodontal their action. recommended because of its numerous maintenance in patients who have had side-effects (changes in taste, swelling of problems with their gums and need Cetylpiridinium chloride the parotid gland, flaking and irritation of to complement their brushing with a These mouth washes have an effect that oral mucosa, increase in the formation of mouth-rinse: essential oils, triclosan, and moderately inhibits plaque, but have little calculus, staining of the teeth). cetylpiridinium chloride. anti-gingivitis effect.
“Mouth washes, used as a Dr. Antonio Santos complement to mechanical Associate Professor THE methods of oral hygiene, of Periodontology, OPINION OF THE provide an additional benefit International University EXPERTS in the reduction of dental of Catalonia. plaque and gingivitis” www.cuidatusencias.es
Antiseptic mouth washes must include, at least, these five properties: 1 2 3 4 5 Quick, Able to kill Good taste Good price Must penetrate safe, and the plaque the dental- easy bacteria in plaque biofilm to use difficult-to- and reach reach areas difficult-to- reach areas
MOUTH WASHES WITH Mouth washes should be TREATMENT FOR DRY MOUTH ANTI-CARIES EFFECT used to tackle different Xerostomia or the reduction of the saliva These are used in people at high risk of dental problems flow is a common disorder. In these cases, caries. They are washes rich in fluoride the dentist recommends the use of mouth and have an anti-plaque effect. It is very important to follow some washes for oral rinsing, and toothpastes These washes can be used on a daily simple diet and hygiene guidelines for or specific sprays to reduce the sensation basis and help teeth to have a reduced their use to be as effective as possible. of oral dryness and to refresh the mouth. possibility of suffering caries, together Causal factors should be removed, and In addition, good daily hydration and with a correct diet and good oral hygiene. it is recommended to use toothpastes, slow chewing is recommended, along In children, the dose of fluoride should gels, mouth washes, and sprays that with good oral-hygiene technique as well vary in relation to age and care should be contain substances for dental sensitivity. as avoiding smoking and consuming taken that they do not swallow the liquid. The effect is not immediate and alcohol, caffeine, and other irritants. sensitivity decreases over a period of ANTI-SENSITIVITY WASHES several weeks. For people who present sensibility to cold, to heat, to brushing teeth, or to the ANTI-HALITOSIS consumption of acids (citric, vinegar, Halitosis is a disagreeable smell coming carbonated drinks), there are specific from a person’s breath and which is mouth washes of different compositions result of the productions of malodorous that help combat this sensitivity. substances through the degrading of bacteria located mainly in the tongue and periodontal pockets. The treatment of oral halitosis is focused on reducing the number of GLOSSARY bacteria that produce bad odour in the mouth through instructions on oral 1. Dental plaque: hardened layer of bacteria and proteins which forms hygiene, cleaning the tongue, and dental at the base of teeth and molars and cleaning together with the use of a mouth which encourages the appearance of rinse that contains a low concentration of caries and other oral diseases. chlorhexidine (0.05%), cetylpiridinium 2. Mechanical methods of oral hygiene: chloride, and zinc lactate. brushing and interdental cleaning. 3. Orthodontic surgery: mainly aimed at moving the jaw into a more appropriate, more aesthetic, more functional, and healthier position. 4. Gingival infections: infections that affect the gums. 5. Root scaling: a procedure to remove tartar, plaque, and bacterial film from the surface of the teeth and below the gum line. 14 - 15 PREVENTION
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The consumption of tobacco represents one of the main causes of preventable illness and death in the world, and has a particularly negative impact on oral health. Your dentist can be key to help you give How to prevent up this harmful habit tobacco use from the dental clinic?
SECTION CO-ORDINATED BY: THE USE OF TOBACCO AFFECTS the that tobacco contains, it is nicotine that THE OPINION OF Desirée Abellán health of all the organs of our body. generates addiction, similar to that THE EXPERTS Associate professor, Master’s It can be the cause of different types created by the use of other drugs. degree in Periodontology, of cancer, cardiovascular and respiratory UIC Barcelona diseases, and diseases of the reproductive Clinical treatment system … and it has many effects that are of smoking potentially damaging to the health. The treatment of tobacco use can be “The dental surgery provides Furthermore, its consumption has approached from the psycho-social a unique stage for tackling a great impact on the oral cavity and or the pharmacological point of view. tobacco use: users tend to can be considered a risk factor for the The psycho-social focuses on detecting be more receptive to health appearance of oral cancer, lesions in the the addictive habit and in working advice and motivated to mucosa, and periodontal diseases. on strategies that allow a change of improve their lifestyle” Smoking is a risk factor for behaviour, routine, and lifestyle. periodontitis and contributes to the Patients should be asked about their development of the most serious cases consumption of tobacco and should of periodontal disease. Smokers are adopt strategies in relation to this. If the four times more likely to suffer from patient is inclined to kick the habit, the periodontitis and they also present a recommended strategy is 5A; if, on the greater amount of harmful periodontal contrary, the patient does not want to give bacteria and an alteration in the response up smoking yet, the 5R strategy should be of the immune system. As a result, the implemented. (Figure 1). risk that periodontal disease will progress and that teeth will be lost is greater in The 5A Strategy Dra. Regina Dalmau smokers than in non-smokers. Ask about: all patients must be asked President of the National about their consumption of tobacco, Committee for the The villain of the piece the time of the day when they smoke Prevention of Tobacco Use. Today, smoking is considered to be their first cigarette, and the number of a chronic disease and the origin of cigarettes smoked daily addiction could result from biological, Advise: use clear and firm arguments genetic, psychological, and social factors. for stopping smoking and emphasize its Among the thousands of substances negative effects www.cuidatusencias.es
THE OPINION OF THE EXPERTS
“The promotion of healthy habits from the dental surgery should include motivation for giving up smoking, adopting the necessary skills to involve, help, and accompany our patients through the change”
Dra. Regina Izquierdo Associate professor of periodontology at the University of Valencia and spokeswoman for the SEPA management board. Health
Figure 1 advice against smoking Do you smoke?
YES NO Health professionals are reliable sources of information and health advice and are considered a Are you prepared Have you behavioural model for patients to to stop smoking? ever smoked? follow. For this reason, anti-smoking Yes NO Yes NO motivation by health professionals can be a great help in abandoning the habit. According to studies, counselling by 5A 5R prevent Congratulate health professionals can achieve up to strategy strategy relapses and stimulate 30% abstinence from tobacco, and the rates of quitting the habit can incrase to 50% when people are guided by nursing staff. 16 - 17 PREVENCIÓN
A global scourge
ACCORDING TO DATA FROM the World Health Organization (WHO), 63% of deaths across world can be attributed to chronic diseases, for which smoking is one of the main risk factors. Today, about six million people die every year as a result of the consumption of tobacco, and most of them live in developing countries. More than 600,000 deaths occur among non- smokers who are exposed to tobacco smoke. It is estimated that by the 2030 there will be more than eight million deaths per year.
MPOWER: 6 measures to confront the epidemic
IN 2008, the World Health Organization (WHO) created the MPOWER initiative, with the aim of implementing a control of the consumption of tobacco at international level. The six measures of the MPOWER plan allow the epidemic of tobacco use to be confronted and the number of mortal victims to be reduced. Monitor: observe tobacco consumption and prevention policies. Protect: protect the population from tobacco smoke. Offer: offer help for giving up tobacco. Warn: advise about the risks of tobacco. Enforce: ensure compliance with prohibitions on tobacco advertising, promotion, and sponsorship. Raise: increase taxes on tobacco.
“Helping to stop smoking Dra. Bettina Alonso should be an important part Associate professor at THE of periodontal treatment and the Faculty of Dentistry OPINION OF THE implant therapy” of the Complutense EXPERTS University of Madrid. www.cuidatusencias.es
Agree the intervention period: About six million people • If the patient does not want to quit die every year because of smoking now, it is recommended that consuming tobacco he or she be offered help for the future • If the patient is uncertain about giving up the habit, promote the advantages of cessation have now been authorized by stopping smoking health authorities. These are divided into • If the patient wants to stop smoking, products that provide a substitute source offer him or her a strategy for giving up of nicotine and those that do not contain the habit nicotine. Aid: When the patient has decided to quit the habit, a “Stop Day” is selected Nicotine replacement within the next two to four weeks; it is products essential that this date does not coincide Designed to provide nicotine to the body with periods of high stress for the patient. in controlled amounts and to help the smoker disengage from the consumption To consider of cigarettes. before starting Smokers are four times On sale without medical prescription: more likely to suffer • Transdermal nicotine patches a nicotine- periodontitis • Nicotine chewing gum replacement • Nicotine tablets that dissolve in the Accompany: It is recommended to carry mouth therapy… out a monitoring of the patient, with On sale with medical prescription: check-up visits: the first two weeks after • Nasal aerosols and oral inhalers PREGNANCY AND BREAST-FEEDING: the “Stop Day” and the second a month pregnant and breastfeeding women later. Products that do not contain nicotine (with medical can use these products only with the The 5R Strategy prescription) approval of their health professionals. Relevance: remphasize to patients the There are two medications that do not CONSULT YOUR DOCTOR IF: importance of stopping smoking both contain nicotine approved by the US · You suffer from diabetes, cardiac for their own health and for that of those Food and Drug Administration (FDA) as diseases, asthma, or stomach ulcers around them products for stopping smoking: · Have recently suffered a heart attack Risks: help them to identify the health • Champix® (varenicline) · Suffer from hypertension that is not risks associated with smoking • Zyban® (bupropion hydrochloride) controlled with medication Rewards: stress all the benefits that Both products have been evaluated · Have a history of irregular heartbeat will be obtained by giving up smoking: by relevant health authorities and it · If you take prescription medication health, economic, better smell… has been determined that the benefits for depression or asthma Resistance: identify the reasons why produced outweigh the risks. However, the patient is resisting quitting smoking if you are thinking of taking one of these IT IS RECOMMENDED TO STOP and offer help to overcome these barriers products, carefully read the product THE TREATMENT AND VISIT YOUR (weight gain…) guide and consult a medical professional DOCTOR if you note nausea, dizziness, Repetition: reiterate this strategy in about any concerns about their negative vomiting, irregular or accelerated a systematic way to raise awareness effects, risks, ingredients, warnings, or heartbeat, mouth problems with the of smoker-patients so that they make any other doubt that might arise. consumption of the tablets or chewing attempts to stop smoking gum, reddening or inflammation around Pharmacological treatment is the patch that does not disappear. fundamental to help confront this habit. Various medications for smoking
“Providing information to Dra. Cristina Vallés young people about the Co-ordinator of the repercussions of smoking Master’s degree in on health is vital to prevent Periodontology at the tobacco use” International University of Catalonia. 18 - 19 TREATMENTS
SECTION SPONSORED BY:
Orthodontics is a branch of dentistry that is involved with preventing, diagnosing, and All you ever treating anomalies in the positioning and relationship of teeth and the bones that house wanted them (maxilla and mandible) to know about orthodontics but were afraid to ask
SECTION CO-ORDINATED BY: What is orthodontic Today, there are many available The placement of Nerea Sánchez treatment? systems: from fixed orthodontic orthodontic devices is Master’s degree in DURING ORTHODONTIC treatment, treatment with metal or ceramic braces frequently associated with periodontology. Complutense slight forces are applied to the teeth aimed (which are placed on the labial or external University of Madrid at moving them in a controlled way to side of the teeth), through lingual changes in habits of oral and improve the relationship between the orthodontics (apparatus cemented to the general hygiene upper and lower set, to correct crowding inside of the teeth), to transparent and and align the teeth, to close gaps… removable aligners. Each treatment mode The accumulation of plaque on the and, ultimately, to improve masticatory has its specific indications, adapted to gums can lead to their inflammation (or functioning, aesthetics, and/or hygiene. each person. gingivitis) and consequent bleeding. Over Advances in science and technique have time, continued inflammation creates a increased the range of devices for the How can predisposition to “gingival enlargement” placement of the teeth. orthodontic devices or the chronic increase in the volume of affect the gums? the gums which, in turn, makes dental The placement of orthodontic devices hygiene even more difficult. To prevent (brackets, arch wires, rubber bands…) these problems, regular visits to the is often associated with changes in specialist for checking and cleaning oral-hygiene habits and in the health of the teeth and gums are advised, as the gums. The presence of these devices well as using mechanisms for the total can make tooth-brushing more difficult, cleaning of the teeth. On the other hand, which can create an obstacle for the a successful orthodontic treatment can removal of bacterial plaque. It can also be a valuable ally for oral health, as the hinder the use of tools for interdental alignment of teeth that were previously cleaning, such as floss or tape. “crowded” can greatly facilitate their Because of this, to adapt to the new brushing and cleaning. situation, devices that enable cleaning between teeth will be needed.
“For orthodontics to be a Dr. Domingo Martín success, it is essential that Orthodontist. THE the gums are in good health OPINION OF THE and this requires that the EXPERTS patient takes care of their oral hygiene” www.cuidatusencias.es
Before orthodontics, healthy gums
IT IS CRUCIAL TO HAVE healthy Because of this, it is important give us a thorough check-up Even with healthy gums, regular gums before starting to move the to keep in mind that the prevalence of the gums and thereby rule check-ups and cleaning of the teeth; if not, the accumulation of of periodontitis (or gum disease) out the presence of gingivitis gums is recommended to prevent bacterial plaque below the gums can increases in line with the increase (inflammation of the gums) or the appearance of problems, as produce inflammation and trigger in age, and there is a marked periodontitis. In the case of gum orthodontic devices encourage the the destruction of the tissues that increase in the disease between disease, it will be essential to treat accumulation of bacterial plaque. support the teeth. the third and fourth decades of life this before starting orthodontics The number of adults who (with a peak at 38 years old). and carry out regular maintenance demand orthodontic treatment to As a result, before starting any visits to keep the gums healthy align their teeth and improve the form of orthodontic treatment, during the placement of our teeth appearance of their smiles is growing. our dentist or periodontist must and afterwards.
Orthodontic treatment tries In people in orthodontic treatment with regular visits to the dental clinic every 4-6 to improve masticatory braces, the wires make it impossible to months for check-up and close cleaning functioning, aesthetics, and/ use floss or dental tape, so it is advisable of the gums – must be followed. or hygiene to use “threaders” or very rigid floss that can be put between the teeth. Interdental Can orthodontics help How to clean teeth if we wear brushes, available in different diameters overcome the consequences orthodontic apparatus? according to the size of the space, are of periodontitis? also very useful, as they not only allow Often the placement of teeth is BRUSHING cleaning between the teeth but also necessary to reverse the consequences We should brush after every meal with a correct cleaning of the area between the of periodontitis as, in advanced phases, medium or soft toothbrush, cleaning the wire and the brackets. this disease can produce the so-called gums, the teeth, and the braces. According “syndrome of pathological dental to various studies, electric brushes MOUTH WASHES migration.” with oscillating-rotating technology As a supplement to help oral hygiene, the In this case, as a result of the loss of the (conventional round head or a specific one use of mouth washes with fluoride or anti- support of the teeth and other factors, for orthodontics) and a high number of plaque agents is recommended to reduce an alteration in the position of the teeth revolutions per minute are very efficient at the appearance of demineralisation of the is produced which can have negative removing bacterial plaque. enamel, caries, and inflamed gums. functional and aesthetic repercussions. However, this is not a substitute for the This syndrome is characterised by FLUORIDE TOOTHPASTE necessary brushing nor the use of other the appearance of spaces between the The difficulties in oral hygiene can also devices for interdental hygiene. teeth that were not there before, the encourage the formation of caries; to fanning out of the upper teeth (movement reduce their appearance and to strengthen If I suffer from periodontitis, towards the exterior), or the loss of the the enamel it is advisable to use a can orthodontic devices harmonic relationship between the upper toothpaste with high fluoride content be placed? and lower arch. To treat this disorder, (>1450ppm). If we suffer from periodontitis and if there is a significant alteration, as the disease is NOT under control, we well as controlling gum disease it will INTERDENTAL HYGIENE CANNOT be treated with orthodontics. be necessary to return the teeth to their Brushing is the main tool for correct First, it is necessary to treat and stabilize original position. oral hygiene, but it does not eliminate the disease. bacterial plaque effectively from the areas To start orthodontic treatment, between the teeth. So it is necessary to use periodontal disease must be controlled interdental hygiene devices every day. and periodontal maintenance – with
“The technique of invisible Dr. Kamy Malekian aligners in the periodontal Collaborating professor patient allows an excellent of the Master’s degree plaque control and a in orthodontics, result that is aesthetic and Complutense University functionally stable over of Madrid. time” 20 - 21 INTERVIEW
SECTION CO-ORDINATED BY: Assumpta Carrasquer Professor of Master’s degree A person in periodontology and implants. Faculty of Dentistry, University of Valencia cannot be considered healthy if they
ADRIÁN GUERRERO PRESIDENT OF THE have a periodontal SPANISH SOCIETY OF PERIODONTOLOGY (SEPA) disease”
Gum diseases are among the most The lack of oral care and infrequent visits to Although much work remains prevalent diseases in the global population. the dentist is nearly always attributed to the to be done, we are moving in It is estimated that eight out of every high costs. Is this criticism justified? the right direction in promoting In effect, dental treatment is costly, like any 10 Spaniards older than 35 has some oral health periodontal disease and it is calculated other medical treatment, but the latter is that about 10% of the population presents covered by social security, which means that advanced periodontitis. But, most the end-user is not aware of the costs involved. People are understanding that bleeding importantly, the impact of these diseases That said, prevention is accessible to gums are not normal and that an early is not limited to the mouth but also has everyone. The efforts directed towards diagnosis not only prevents complex dental repercussions on general health. prevention will have an impact on the and oral problems but also facilitates general patients’ economy, reducing the cost of future health. Is oral health still a question of unfinished treatments; but, in addition, prevention in At the institutional level, the Spanish Society business for the Spanish population? oral health has an impact on the individual’s of Periodontology, which was founded in 1959, In general, the population is more aware of the general health. is reaping the harvest of all the good work sown importance of oral health. The child population by the management boards who have been is cared for from very early ages and instructed The prevention of oral disease working for almost 60 years. The involvement, in oral-hygiene measures with the aim of is very cheap and accessible to commitment, and delivery on the part of preventing future pathologies; for its part, the everyone, and has a positive SEPA members and their partners means that adult population is already conscious of the periodontology is living this great moment, to impact on general health impact that oral health has on quality of life the benefit of the population as a whole. and general health. Although there remains much to do, we are Do you consider, then, that the prevention of In this respect, what role is being played moving in the right direction in promoting oral periodontal diseases is relatively cheap and by the Alliance for Periodontal and General health. simple? Health? Both gingivitis and periodontitis, which are the This alliance is a scientific co-operation How do you evaluate the image that most frequent gum diseases, can be prevented initiative that has been driven by the SEPA society has of dentists? from early ages by correct oral hygiene and Foundation with the aim of informing, Until now, society has associated the dentist by controlling risk factors that favour their researching, and providing knowledge to all with a profession tied solely to aesthetic and appearance (mainly smoking and control of health professionals about the relationship functional treatments, but the reality is that diabetes). Furthermore, the cost of a visit to the between oral health – principally the health of dentists are health professionals. dentist to prevent disease is much lower than the gums – and general health. All this with a This fact is being understood by some sectors the cost implied by the loss of dentition or the single final objective: to improve the health of of society, who are concerned about their need for its complete repositioning. the population and the patients whom we treat quality of life, about their wellbeing, and about every day. general health, and who see in the dentist a Are we seeing a real golden age of The approval of the partner scientific professional who can help them to prevent and periodontology in our country? societies is very positive, and we have treat oral pathologies and, at the same time, to Among the general population, the word established very close bonds of co-operation maintain appropriate general health. “periodontology” is increasingly well known. with cardiologists, diabetologists, www.cuidatusencias.es
“Periodontal diseases are associated with more than 50 pathologies”
What is periodontology and what does it deal with?
PERIODONTOLOGY IS the specialism within dentistry that is concerned with the care of the gums, both of natural teeth and of dental implants. When the gums are healthy they form perfect seals around teeth or implants; however, when they are infected, these gums lose their sealing and allow bacteria to gain access to the blood stream. In addition, if these diseases are not stopped in time, the loss of bone around the teeth can provoke the loss of teeth or implants. The good news is that the prevention of these diseases is easy and their treatment, if we arrive too late for prevention, is relatively straightforward. 22 INTERVIEW gynaecologists, primary-care doctors, Logically, the loss of dentition has a very The word “periodontology” pharmacists, and other health professionals. important impact on the quality of life of the is more and more known by patients and on their nutrition, as this implies the general population How would you assess the growing that they will not be able to chew properly. involvement of medical scientific societies in the promotion and improvement of oral And how do they affect general health? Is the increase in peri-implant diseases health? They affect general health because the worrying? Very positively. They understand that health bacteria that produce the infection of the Dental implants are not free of infections; should be approached from an integrated gums enter into contact with other organs it is estimated that infections around dental point of view and that oral diseases have through the circulation of the blood. implants affect 30% of the people who have their impact at a general level. Cardiologists Also, the inflammation that appears as them. In this case, the treatment of these are already implementing a programme of a consequence of these periodontal bacteria diseases is not so predictable, and more prevention of oral diseases among patients can provoke a systemic inflammation that studies are needed so that dentists can who have suffered a heart attack. can aggravate or activate other inflammatory understand which treatment would be the Diabetologists are informing their patients processes, such as cardiovascular diseases, most suitable. that good gum health influences directly diabetes, or certain adverse pregnancy However, prevention is effective. the control of their diabetes. Gynaecologists outcomes, including premature or Someone with dental implants should ensure are recommending pre-conception visits to low-weight birth. meticulous hygiene of all the tissues around the dentist with the aim of prevent possible the implant as part of their routine. adverse effects of future pregnancies. And Early diagnosis not only prevents primary-care doctors are more than ever complex oral problems but also With all this, do you believe that people pay aware of the need to give their patients sufficient attention to periodontal diseases? recommendations about oral health. favours general health Normally no. In contrast to caries, they are not painful, and this means that they often What repercussions do gum diseases Can a person be considered healthy if pass unnoticed. But we know that the simple have on oral health? they have a periodontal disease? bleeding of the gums is already an indication The local repercussions of periodontal Clearly not. There is an epidemiological that something is not right with our oral diseases start with gingival bleeding and the association demonstrated in many studies health and that we should go to the dentist for inflammation of the gums which start to look that shows us that patients who have a check-up. blotchy. If the process is not stopped at an early diseased gums have poorer control over their If this is not done in time, the later can see stage, gum retraction can appear, along with glycaemia, a higher risk of suffering from gum retraction, tooth mobility, and separation tooth mobility, halitosis or bad breath, high cardiovascular diseases, expectant mothers between the teeth. If sufficient attention is dental sensitivity, separation of teeth, and – present pregnancy complications with greater paid to these signs and professional help is ultimately – the loss or falling out of the teeth. frequency… sought in time, these diseases can be treated Periodontal diseases are associated with little problem. with more than 50 pathologies, including rheumatoid arthritis, Alzheimer’s Disease, and Public-health managers must In your oral hygiene, even erectile dysfunction. opt more for prevention and must finance the coverage of remember the rule Can gum diseases be considered as a kind of two of indicator or thermometer of a person’s periodontal treatment general health? To a certain extent, yes. Some serious diseases From the point of view of public-health THE PRIMARY PREVENTION of oral diseases of the organism, such as HIV or certain managers, does more need to be done to is based on performing correct daily hygiene diseases related to the defences, manifest first reduce the impact of these diseases? and a check-up by a dentist once or twice per of all in the gums. The key is that they back prevention and year. It is known that the combination of good finance the coverage of periodontal treatment hygiene and professional supervision prevents Of the periodontal diseases, which give – at least for risk groups, such as people gum diseases, as well as caries, in a very high most cause for concern? with diabetes, people with heart disease, and proportion of the population (close to 96%). Gingivitis and periodontitis, which are very pregnant women. In terms of basic advice on oral care, common and connected with each other. Dr. Adrián Guerrero says that “it is very All gum diseases start with gingivitis, which important to follow the rule of two”: clean the involves a superficial inflammation of the gums. If this is not treated in time, it gives teeth at least twice a day, for two minutes, way to periodontitis. using two types of brush (one to clean the A recent study of the working population outside and inside of the teeth, and the other in Spain shows that periodontitis in the to clean the point of contact between one adult population is very common, with its tooth and another using interdental brushes advanced form affecting one in four people. or dental floss), and with the aid of two But the majority of these cases can be treated therapeutic agents (toothpaste and, when successfully, maintaining the patients’ natural indicated, a mouth wash). dentition and reducing the economic costs of complex treatments.
24 - 25 DID YOU KNOW THAT…? Dismantling 10 myths in oral health
The lack of knowledge or lack of concern with 3. Orthodontic 4. Gum retractions 5. My saliva causes a oral health in our country has led to widespread treatment is only are the result of age lot of tartar to form errors and beliefs with little or no scientific basis. for children These are some of the most common. Retractions of the gums (that Saliva is 99% water, and is, the loss of gum or bone that the remaining 1% comprises Let’s carry on dismantling the myths! Orthodontic treatment can be carried out at any age, with the exposes part of the root of the organic and inorganic molecules. only necessity being that the oral teeth) are not related to age. Bacterial plaque3 is a biofilm cavity is healthy. They can also occur in young made up of bacteria and salivary 1. It’s normal that 2. Periodontal Controlling inflammation of patients, either as the result of compounds. gums bleed … and, diseases are not the gums and the absence of vigorous or energetic brushing The first phase of formation anyway, it doesn’t hurt contagious bleeding are especially important that damages the tissues, tooth of this biofilm takes place within during the whole treatment. malposition, or through the minutes of having performed a There is an erroneous idea that Periodontitis is an infectious The prior diagnosis of any presence of piercings – all of correct cleaning of the teeth. bleeding gums is something disease produced by bacteria periodontal disease is essential, which facilitate root exposure. This happens through the normal; however, bleeding is one and it is logical to ask if it can as it can worsen during the This situation can be treated irreversible adhesion of oral of the few signs that warn that be transmitted to children and orthodontic treatment if it has and corrected through gum bacteria, constituting the base 2 the gum is diseased. A healthy partners. not been treated correctly. grafting, to improve both health for colonisation; this phase lasts gum should not bleed. In published studies, one Optimal and excellent levels of and aesthetics. Your periodontist from 4 to 24 hours. Gum diseases do not appreciates a presence of the oral hygiene are also required to can inform you of the available If this acquired biofilm is produce pain and can pass same bacterial profile in both avoid the formation of bacterial techniques and when it is not removed by brushing (at unnoticed, typically detected members of the same couple plaque and inflammation. suitable and necessary to deploy least once a day, meticulously), only when there has been when they have lived together The controlled movements them. it will produce a secondary colonisation during the following extensive and irreversible bone for more than ten years: these of orthodontics in treated Retractions of loss. When pain appears, it is the pathogens have also been periodontal patients do not days (1-14); it is here where the gums have no unequivocal sign of the existence observed in children. produce additional bone loss; on germs multiply, increasing the of a more significant pathology This supports the hypothesis the contrary, they are beneficial relation to age thickness of the plaque and and, as such, something that of horizontal transmission for occlusion, function, and mineralising it, creating calculus requires more effort and cost (between couples) and vertical stability over the long term. or tartar. to treat. transmission (parents- It is true that, as a result Orthodontic Do not wait until you feel pain children), and curiously atypical of the pH, there are people before going to your dentist, and periodontal pathogens1 have treatment can be with greater and more rapid thereby avoid more costly and been found in cats and dogs, performed at any age; formation of tartar, but this complex treatments. which suggests that humans it is necessary only can be avoided with correct, can transmit these micro- that the periodontal comprehensive, and thorough A healthy gum should organisms to our pets. disease is treated brushing during the first 24 hours of the formation of plaque, not bleed and when So, when one member of a and controlled and stable couple has periodontal avoiding its calcification. it causes pain it that there is no disease he or she can infect Correct, means that significant the other, if there are suitable inflammation comprehensive, damage has already conditions of bacteria to which taken place they have genetic susceptibility. and thorough Because of this, it is brushing during highly recommended that the first 24 hours of the periodontist evaluates plaque formation the partner of a patient with minimises the periodontal disease and their forming of children once they reach adolescence. tartar When one member of a stable couple has periodontitis, they can transmit the bacteria to the other who, SECTION CO-ORDINATED BY: if susceptible, can Rosa Puigmal develop periodontal Master’s degree in periodontology. University of Barcelona disease www.cuidatusencias.es Dismantling 10 myths in oral health
6. Tobacco only 7. My gum problems 8. I brush three times 9. The electric brush 10. I am old: I can’t stains my teeth remain in my mouth a day: my gums are damages my gums have implants and healthy and teeth they are not worth The damage caused by tobacco There is now solid evidence the bother goes beyond the stains that of the relationship between The efficacy of the battle against The incorrect use of the electric it provokes. Furthermore, it periodontitis and other common periodontal diseases is not brush can produce abrasion Optimal masticatory functioning can encourage bad breath or disorders, such as diabetes, directly and exclusively linked to on the teeth and retraction of is of great importance regardless halitosis, and – above all – it is cardiovascular diseases, adverse the type of brush or the number the gums, but not as a direct of age. Today, life expectancy a silent threat and a real factor pregnancy outcomes, and of times we brush our teeth, but consequence of the brush itself is longer and longer and this for the failure of periodontal and respiratory diseases. also to the degree of motivation, but fundamentally because of means that rehabilitation implant treatments. It is thought that access to difficult locations, and the technique employed, the treatments with implants are Smoking is the cause of periodontitis, as an inflammatory the time employed. Basically, use of abrasive toothpastes, and being performed on older and a wide variety of diseases disease, has the capacity to to the enthusiasm with which the type of bristles (especially older patients. Advanced age and a risk factor for suffering spread this inflammation we do it. hard ones). is not a condition for placing periodontitis. to other parts of the body, The correct brush position The efficacy of implants; the only limitation is Smokers have three times provoking a classic effect during sufficient time on each the health of the patient. more risk of suffering periodontal of systemic disease. The tooth-brushing is tooth optimizes the result. But there is a minimum age. disease, and tobacco makes inflammation produced by not directly and The technique The patient must have finished this progress more rapidly periodontitis is not local; exclusively linked to the period of growth (roughly and lessens its response to thus, we should make an oral the type of brush or employed, the use of between 18 and 25 years, treatment, leading to the loss evaluation to avoid the possible the number of times abrasive toothpastes, depending on sex). of teeth. repercussions in physical and the time of Together with alcohol, it is the conditions and general health. that we clean our It is never too late teeth bristles can damage main cause of oral cancer. People who are physically the teeth; the possible to start a treatment active have a greater capacity Tobacco use is a key damage does not, with implants if this is to avoid the risks associated indicated factor in the failure with periodontal disease. A good therefore, depend on of periodontal and recommendation is to exercise, whether the brush is implant treatments to reduce the risks of systemic manual or electric diseases associated with periodontitis. Periodontitis is characterized by the presence of inflammation which, through difference mechanisms, extends to other parts of the human organism
GLOSSARY 1. Pathogens: bacteria or micro-organisms 3. Bacterial plaque: also called biofilm. that cause infectious diseases. These are complex microbial 2. Gum grafting: a technique of periodontal communities, formed above all by bacteria plastic surgery which consists of placing of that stick to hard surfaces such as teeth. gum tissue from the palate or substitute 4. Systemic: having a relation to the whole materials to improve the band of gum of a system. In health terms, it implies around a tooth and to maintain health or that it affects the general level – that is to to cover the exposed roots when there are say, various organs or systems. gum recessions and to improve aesthetics; through this, the appearance of “long teeth” is corrected. 26 - 27 REPORT The “litmus test”of Social concern for following correct guidelines for oral hygiene is increasing in our country but, in many cases, there are still questions about whether these practices are oral being performed correctly hygiene
SECTION CO-ORDINATED BY: THE ACCUMULATION OF Without plaque control, The oral-hygiene technique Olalla Argibay BACTERIAL plaque on the surfaces certain failure that is used conditions the Master’s degree in of the teeth is responsible for the As with a house, having good foundations periodontology and implants, maintenance of good oral University of Santiago de development of the main diseases that is an indispensable requirement for health and the risk of losing Compostela appear in the mouth: caries, periodontal assuring the stability and quality of what diseases, and peri-implant diseases. they support. teeth Using an adequate oral-hygiene In the mouth, we have a very similar technique will condition the maintenance situation: the maintenance of supporting Periodontal disease has a great impact of good oral health and ultimately reduce tissues (bone, periodontal ligament, and on the aesthetics of the smile of the the risk of losing teeth. gums) that support the teeth in the mouth patient. The appearance of retractions, Prevention programmes in which is essential. black spaces, inflammation, bleeding, or patients are informed and instructed Most treatments demanded by patients pathological dental movement can lead in the importance of prevention and are related to aesthetic reasons and the to the long-term failure of any treatment maintaining correct hygiene measures first thing that dentists need to bear that has been carried out. Because of over the long term should be established in mind is the “white aesthetic” – that this, a correct diagnosis of this type of in a routine way in the dental clinic. is to say the tooth. However, the “pink pathology, an appropriate treatment, aesthetic” – that which refers to the gums – and – of course – a good programme of can be responsible for the aesthetic failure maintenance and control of bacterial of any treatment carried out on the tooth. plaque is necessary.
“The duration of brushing Dra. Reyes Jaramillo and the method used are Associate Professor at THE key to maintain proper oral the Faculty of Dentistry, OPINION OF THE health” University of Seville. EXPERTS www.cuidatusencias.es
Resources The recommendation of using one spaces between the teeth because of the or other device should come from the loss of supporting bone (periodontitis), the for removing professionals, and it should be they who use of interdental (interproximal) brushes bacterial evaluate the most suitable device for each is advised. patient and at each point of treatment. There are many sizes and formats of plaque: interdental brushes in the market. The INTERDENTAL BRUSHING right size and most suitable thickness of Resolving With tooth brushing, bacterial plaque is brush for the anatomy of these spaces doubts eliminated from the outside and inside of should be chosen and changed according the teeth but not from the spaces between to morphological changes in the gums the teeth. To clean these spaces, the most resulting from the progress of the widely used and effective alternatives are treatment plan. MANUAL VS ELECTRIC BRUSH dental floss and interdental brushes. Brushing these zones completes the The removal of dental plaque by means Generally, dental floss is used when hygiene carried out with normal brushing of tooth-brushing helps to prevent the the space between the teeth is closed or and should be established as a habit at inflammation of the gums (gingivitis). is very narrow (without bone loss least once a day, as not doing so implies This dental brushing can be carried out around the teeth). leaving about 40% of the dental surface with manual brushes (using different When there uncleaned. techniques) or electric ones. are open Electric toothbrushes are those that MOUTH WASHES simulate manual brushing in various Mouth washes or mouth rinses are basic ways, such as moving from side or side products in dental cleaning which help or in a circular movement. The review of improve the health of our mouth, but which various studies shows that only rotation do not replace brushing or cleaning between and oscillation (when the head of the the teeth. There is scientific evidence brush moves in one direction and then that shows that mouth rinses in the other) is better than manual contribute to the prevention and brushes in removing plaque and treatment of mouth diseases, reducing inflammation. Furthermore, thus helping to maintain a with this type of brush there is no healthy mouth for longer. possibility of damaging the gums. They should be used at least once a day, always after brushing and kept in the mouth for 30 seconds, avoiding eating or drinking anything for half an hour after their use. Taking into account the different formulas of mouth rinses that are available today in the market, it is best that the dentist recommends which one to use, as he or she will best know the needs of each patient and what would be the most suitable treatment. “Antiseptic mouth rinses are complementary to the mechanical systems of bacterial-plaque control to improve oral hygiene”
Dra. Isabel Lanzós “The regular reinforcement Dr. Luis Pavillard Periodontist. of oral hygiene techniques Department de by a profesional is vital for Periodontology, Faculty the patient’s correct and of Dentistry, University sustained motivation” of Seville. 28 - 29 REPORT
Without these conditions of prior Short brushing time, The greater the number of changes it is health, treatments with dental implants inadequate brushing desired to introduce, the harder it will be or orthodontics are completely counter- technique, and the lack of an that they are implemented. indicated, as their success would be ordered brushing sequence constrained. Brushing technique are the most common errors A multitude of brushing techniques with Incorrect habits in dental hygiene different objectives have been described. Although we usually assume that Thus, a brushing technique can be everyone knows how to brush correctly, Information, motivation, and education indicated for one type of patient but not the reality is completely otherwise. of patients must be done in a continuous for another; because of this, it is our Ever since we were little, few of us way. Throughout the different phases of dentist who must guide us. have received instructions on brushing treatment, the hygienist should carry out First the patient’s habitual brushing techniques and on how to use the this important job, evaluate the advances must be evaluated, to see if it is effective different types of toothbrush that can be made by the patient, and detect any errors at eliminating dental plaque and that it found in the market. and difficulties that arise. In visits for does not damage either teeth or gums. The hygiene habits of the general professional cleaning, maintenance, and population are generally rather poor. specific hygiene-control visits, time must Not having healthy gums Short brushing time, inadequate be reserved that is dedicated specifically can be responsible for the brushing technique, and the lack of an to this area, individualizing the training ordered brushing sequence are the most that is offered according to the needs of aesthetic failure of any common errors noticed by dentists when the patient. treatment carried out in the they evaluate their patients’ brushing tooth techniques. It is estimated that some 75% Basic hygiene instructions of patients who visit dental clinics have The accumulation of plaque varies An inadequate technique, in which the a bad brushing technique; this is not considerably between patients. Each brush is moved in a horizonal direction, always because of a lack of motivation person accumulates a greater amount can begin to reveal the roots of the teeth, but sometimes because there is a lack of plaque and calculus in a specific area create more exposure to caries, and of instruction and training about the conditioned by the brushing technique create concavities in which the tooth’s technique to use. and the anatomical conditioning factors nerve can begin to be affected. All this of each patient. Before introducing implies not only an aesthetic problem Role of the dental team changes, it is necessary to evaluate the but also increases the risk of sensitivity Starting from this reality, a determining brushing technique and detect possible when eating hot or cold food, which role is played by the members of the errors that are being committed. Using would continue to worsen if the brushing dental team. Dentists and hygienists plaque detectors is a very practical way technique is not corrected. make up the team responsible for oral to show the patient and at the same health and are in charge of a correct time evaluate their brushing with the diagnosis of the diseases present in the aim of introducing any changes that are mouth and of establishing a suitable considered necessary. treatment for each of them. But, without In later visits, this will also allow doubt, the most important task is that checking whether the guidelines that have of informing and educating patients been given have been correctly included in techniques of prevention and oral in the patient’s routine. hygiene. For their part, patients should We should not forget that in order maintain their oral health, performing the to acquire hygiene habits, these must indicated hygiene techniques. become part of the patient’s daily routine.
“With good oral hygiene, Dr. Andrés Pascual gums present a pink colour Director of the Master’s THE and do not hurt or bleed degree in periodontology, OPINION OF THE during brushing or cleaning International University of EXPERTS with dental floss” Catalonia
30 - 31 SEPA OUTREACH
Led by leading Spanish scientific societies and promoted by the SEPA Foundation and the Spanish Everyone with Society of Periodontology and Osteointegration (SEPA), the Alliance for Periodontal and General Health is consolidating the Alliance for and growing Periodontal and General Health
SECTION CO-ORDINATED BY: IN THE FRAMEWORK OF THE In terms of initiatives that are being The aim is that in the coming Mónica Muñoz Complutense University of Madrid’s carried out within the framework years the project with Master’s degree summer courses, there was a of this Alliance, SEPA has reported consolidate among scientific in periodontology. presentation of the achievements and on the creation of joint protocols of Complutense University the challenges facing the members clinical application for oral-health societies, universities, of Madrid.Certified in businesses, and public implantology. Univiveristy of the Alliance for Periodontal and professionals to act in the primary of the Basque Country General Health – an entity driven by the prevention of cardiovascular diseases. It authorities in Spain Spanish Foundation of Periodontology is also working on the early detection of and Dental Implants, in collaboration diabetes and on initiatives to promote services offered by the national health with the Spanish Society of Cardiology healthy lifestyle habits, with the aim system, at least for specific groups of (SEC), the Spanish Society of Diabetes of promoting periodontal and general patients such as those who suffer a (SED), and the Spanish Society of health. cardiovascular disease or people with Periodontology (SEPA), and which Specifically, and within the diabetes.” has been subsequently joined by, framework of the Alliance, As, according to Dr. Mariano Sanz, among other medical organisations, programmes are being developed for director of the course and a world the Spanish Society of Obstetrics and for the prevention of periodontal and leader in periodontology, “the care of Gynaecology (SEGO) and the Spanish peri-implant diseases, for tobacco periodontal health must be an integral Society of Primary-Care Doctors cessation from the dental clinic, the part of the treatment received by a (SEMERGEN). promotion of cardiovascular health person with diabetes, and it is necessary in periodontal health and periodontal to establish specific periodontal care for Present and future health in cardiovascular patients (in cardiovascular patients.” “The solid evidence that confirms the collaboration with the Spanish Society From the perspective of prevention, links between certain diseases of the of Cardiology), of encouraging women’s it is even suggested that there are gums with other systemic diseases health and lifestyle (with the Spanish important benefits of the role that can necessitates a multidisciplinary Society of Obstetrics and Gynaecology), be played by periodontal health and integration to confront this problem,” and the early detection of diabetes dental check-ups in this area. said Dr Adrián Guerrero, president in the dental clinic (with the Spanish According to Dr. Sanz, “the experts of SEPA. “This need to establish a Society of Diabetes). in oral health are health professionals framework of collaboration between the who treat a higher percentage of the professionals involved has been covered Message for healthy population, which puts us by the creation of the Alliance for health authorities in a privileged position to carry out Periodontal and General Health in 2016, This course also had a clear and agreed prevention.” In this line, he emphasises but it is now necessary to take some message for the country’s health that “the utility of diabetes screening in more steps forward and we shall soon authorities: that they should be open the dental clinic has been demonstrated know the results of the first research that to the new evidence that confirms the as has the efficacy of including in our has arisen from this Alliance.” impact of periodontal health on general consultations programmes to control The aim is that in the coming health and, above all, listen to the call to certain risk factors and to promote years, the project will be consolidated include certain periodontal treatments health (smoking, obesity…). among scientific entities, universities, in public financing. businesses, and public authorities In the opinion of the SEPA in Spain, and also expand to other president, “periodontal treatment countries. should be included in the portfolio of From left to right: Antonio Bujaldón, Manuel Anguita, Adrián Guerrero, Mariano Sanz, Antonio Zapatero, José Luis Llisterri, and David Herrera
In the context of a summer course at the Complutense University of Madrid (UCM), carried out in What they said… collaboration with the Spanish Society of Periodontology (SEPA), national leaders such as Antonio Bujaldón (SEPA), Manuel Anguita (SEC), Adrián Guerrero (SEPA), Mariano Sanz (UCM, SEPA), Antonio Zapatero (SEMI), José Luis Llisterri (SEMI), and David Herrera (UCM, SEPA) reviewed some of the most current and controversial aspects of oral health and their implications on general health. These are some of the most outstanding contributions:
Mariano Sanz. David Herrera. Adrián Guerrero. Juan Girbés. Manuel Anguita. José Luis Llisterri. Antonio Zapatero. Professor of Professor of President of the Co-ordinator of the President-elect of the President of the President of the Periodontology, Periodontology, Spanish Society Diabetes Unit of the Spanish Society of Spanish Society of Spanish Society of Faculty of Dentistry, Faculty of Dentistry, of Periodontology Valencia Department Cardiology (SEC). Primary-Care Doctors Internal Medicine Complutense Complutense (SEPA). - Hospital Arnau “Cardiologists (SEMERGEN). (SEMI). University of Madrid. University of Madrid. “It is not possible to de Vilanova - Liria. should make “Oral health is the “The infection Director of the course. Secretary of the have good general Member of the Spanish patients aware of most common and inflammation “The experts in oral course. health if the health Society of Diabetes the importance of unmet health need that characterize health are health “There are now more of the mouth is (SED). periodontitis as in a wide range periodontitis means professionals than fifty systemic poor. The health of “People with diabetes a risk factor for of vulnerable that, by different who treat a higher diseases that have the mouth is not should pay special cardiovascular populations… means, this disease percentage of the been associated independent of the attention to their diseases. They Because of this, present in the oral healthy population, with periodontitis, health of the rest periodontal health: should give patients family doctors must cavity extends to which puts us which highlights of the body, and not only do they questionnaires on pay greater attention other parts of the in a privileged the impact that general health can have an increased periodontal health to the oral health of organism, acting as position to carry out gum health has on also influence oral risk of suffering and refer those with our patients” a systemic disease” prevention” general health” health” periodontitis, but periodontal disease they can lose control to their dentist” of their blood-sugar levels if this disease is present in the gums”
Interdisciplinary Alliance The Alliance for Periodontal and General The ultimate aim of this Alliance is to try to Health is “a pioneering initiative in the world, achieve that the different health professionals with a common goal which defends the role of the dentist as a form a team, seeking interdisciplinarity, health promoter and an ally in the prevention carrying out prevention and treatment plans and detection of systemic diseases, such together: each professional with his or her as diabetes or certain cardiac diseases,” specific knowledge and also considering the emphasised Dr. Adrián Guerrero. role that should be played by each patient. 32 - 33 SEPA OUTREACH
It is estimated that more than a million of adult Catalans have a gum disease and that in a quarter of New allies these people the disease is a serious condition. Hence the interest of the Catalan Society of Dentistry and to fight Stomatology in confronting periodontal this growing problem diseases
LEADING SCIENTIFIC SOCIETIES, Hand in hand The Catalan Society of such as those of cardiology, diabetes, Now, the Spanish Society of Dentistry and Stomatology gynaecology, general medicine, Periodontology and the Catalan Society (SCOE) has recently joined and periodontology, together with of Dentistry and Stomatology have professional bodies, businesses, and committed to working together to be able this initiative public entities, have reached agreement to disseminate information about the on fighting periodontal diseases and relationship between oral and general way (such as doctors and dentists) improving the oral and general health of diseases, ensuring that it is the health have worked together with the aim of the population, resulting in the Alliance professionals of the various specialities, co-ordinating their forces in favour for Periodontal and General Health. and not only dentists, who present the of the health of our patients,” and – he facts that are known today. added – “doing so in a multidisciplinary A historic meeting “The aim is to involve all professionals way.” The Catalan Society of Dentistry and who treat or inform patients, in a way that Stomatology (SCOE) has recently incorporates into their knowledge and The first step joined this initiative, in an event held their practice the fact that periodontal Both SCOE’s joining the Alliance and in Barcelona. This was a declaration of and general health are connected,” the celebration of this interdisciplinary intent and a support for the evaluation indicated Dr. Adrián Guerrero, for scientific and outreach meeting are and making known of the close links whom there is no doubt that “the SCOE considered to represent only the first between gum health and general health, is a very well-known scientific society in step. “Our wish is that this event is the and also drawing the attention of the Catalonia” and therefore “the Alliance is starting point of a campaign promoted Catalan health authorities to this reality. strengthened, and even more reinforced not only by scientific societies but also The meeting served as the starting from the scientific point of view through by the health authorities”, stressed the point for projects to improve the an entity that is credible and close to the SCOE president. professional training of professionals health professionals of this region, and the Following this line of argument, Dr. in oral health and general health and spread of knowledge will also be widened.” Nuria Vallcorba, honorary trustee of to encourage awareness among the For his part, SCOE president Dr. the SEPA Foundation, said that “to be population through the promotion of Ernest Mallat, said that “it is a great able to get the health administration health habits. opportunity to make known the existence involved in this field it is necessary to This meeting manifested the of the relationship between periodontal make known the importance of the multidisciplinary vision of leading diseases and general health. We seek relationship between oral and general professionals in different medical to make doctors in various specialities diseases.” and dental specialisms, defending aware of the important role that Furthermore, indicated the Catalan the role of the dental check-up as a controlling periodontal disease can have periodontist, “we must advance in the space with a high potential for health on the state of health of their patients.” knowledge and the evidence, which will promotion and as an ally in the primary In Dr. Mallat’s opinion, “In Catalonia, progressively affect the different fields prevention and detection of systemic it is the first time that the collaboration of health professionals and the health diseases, such as diabetes, and in the between two groups that have often administration.” promotion of cardiovascular health. worked in an independent and isolated www.cuidatusencias.es www.cuidatusencias.es
Catalonia Oral diseases are It is estimated The figures are In addition, it While 84% of the most common that 247,500 not any more is calculated Catalans think that data in human beings. Catalan children encouraging when that 85% of they should go to In the case of under 12 have gum diseases are oral cancers in the dentist at least Catalonia, the caries in primary evaluated, as there Catalonia are once a year, only figures demand teeth, but more are 1,100,000 diagnosed at a 48% have done attention. than 4,500,000 adult Catalans late state, which so in the last 12 Caries and Catalans aged who present is particularly months. periodontal 12 and over periodontitis, worrying as early diseases are have caries in 276,000 of which diagnosis could extremely permanent teeth, are advanced reduce mortality common. and it is estimated or serious by half. that 110,500 periodontitis. people who live in this autonomous community are toothless.
From left to right: José Nart (SEPA), (Col•legi de Farmacèutics de Barcelona), Elías Casals (COEC), Nuria Vallcorba Xavier Garcia Moll (SEC), Pere Beato (SEPA), Ernest Mallat (SCOE), Adrián (SEMERGEN Catalunya), and Pere Guerrero (SEPA), Anna Novials (SED), Serrano (AHIADEC). Margarida Mas (ANIS), Marta Amat 34 - 35 SEPA OUTREACH
For the last four years, May 12 has been celebrated as the “European Gum Health Day” (formerly the “European Day of Periodontology”, an initiative promoted by the European Federation of Periodontology (EFP), but which includes a strong Spanish role ‘European Gum Health Day’, with a Spanish accent
New date In short, European Gum Health Day 2017 was “a great success”, according to the EFP which extended its thanks to all the participating national scientific societies and made a special mention of the work carried out by former EFP president Juan Blanco, who “prepared the way to the establishment of what is today considered an indispensable annual event.” And the EFP is now working on preparing the 2018 edition. The next European Gum Health Day will be co- ordinated by Dr. Xavier Struillou and will take place on May 12, 2018. Once again, the aim will be to raise the awareness of the general population, health professionals, and authorities about the importance of maintaining healthy gums throughout life.
From left to right: IN THIS YEAR’S EVENT, there was The Spanish Society of SEPA’s Casa de Las Encías (Gum Health Juan Ochoa, presenter a record participation with a total of Centre). One of the most important of the event at the Casa Periodontology carried out 27 national societies affiliated to the events was an outreach activity in de las Encías: Regina a wide range of activities to Izquierdo and Adrián European Federation of Periodontology which the report “Periodontal Health, Guerrero (SEPA), Pedro (EFP) jointly celebrating “European celebrate this day Sports, and Quality of Life” – the fruit Manonelles and Carlos Gum Health Day”, highlighting gum of collaboration between the SEPA de Teresa (SEMED). health and its relation to general health. them SEPA, which has been a leader Foundation and the Spanish Society For the first time, there was in this type of initiative), contributing of Sports Medicine (SEMED) – was an unprecedented coverage of practical advice and relevant presented. periodontology in a way that millions information. Together with this, an information of people (from Portugal to Azerbaijan, Thanks to hundreds of volunteer stand was set up in the centre of Malaga from Morocco to Finland) were periodontists and dentists, who took during the Congress of Periodontology informed about the implications of part in dozens of public events, the and Oral Health. periodontal health on general health message of “fighting periodontal disease And there were informational and well-being. together” has been spread widely. talks with the general population and Specifically, the Spanish Society of students, and even informative lectures Success Periodontology carried out a wide range to football teams of the Malaga Football All this has been possible thanks to the of activities to mark this day, activities Club Academy. impressive work carried out by all the that extended throughout the month of participating national societies (among May and which had as their epicentre www.cuidatusencias.es
‘CTE’ modernizes Change of look, same spirit
Following the cuidatusencias.es, philosophy of more information constant evolution and just a click away modernization to make our content closer, more attractive, and more interesting to our INITIALLY CONCEIVED readers, the magazine as a complement to the print version of “Cuida “Cuida tus Encías” [Take Tus Encías”, the website Care of your Gums] has cuidatusencias.es has over launched a change of time gained prominence, timeliness, image in this edition and content. Today, the web is no longer just SINCE ITS LAUNCH, this to keep “Cuida tus Encías” in a digital container of all the various publication has tried to attract the vanguard of design and layout. reports, interviews, and news items the attention of oral-health A restyling has been carried out and published in the magazine. It has professionals, their patients, and there are two aspects to the new become a more important product, ultimately the general population design: one aesthetic and the other providing a much greater amount with informative content related to functional. of information and in a way that oral and general health. At the aesthetic level, after almost is regular, direct, and close to the From the rigour and seven years and 12 issues, there was current demands of the population. professionalism that characterizes a need to update the composition, From cuidatusencias.es, you the Spanish Society of typography, colour… to approach a have access not only to the Periodontology (SEPA) and the more modern and dynamic style. magazine’s previous issues but experts of this scientific society who From the functional perspective, also to new information that is have been designated to develop what has been attempted is to regularly incorporated, along with this magazine, we have attempted deepen the informational character practical advice and useful videos to provide useful knowledge and of the publication’s editorial line, for all people interested in knowing information, always with the final in which the design seeks to aid more about their oral health – with aim of procuring a better oral health reading, whether through striking the security, professionalism, and for the population, in particular headlines, a highlighted phrase, a seriousness that is provided by a advocating the benefits that this suggestive image, or the declaration team of SEPA experts. entails for the general health of of an expert in the matter. each person. In this new stage, white spaces will be boosted, symmetrical Aesthetic and compositions will be broken, and functional change more space will be dedicated to To tackle this challenge, the formal photography and to highlighting the aspect of the publication is key, meticulous editorial work. with the aim of offering the reader We hope it is to your liking! information that is quick, simple, thoroughly examined, attractive, and interesting. Hence the attempt 36 - 37 UPDATE Greater risk of oesophageal
cancer with In adolescence, your oral health diseased gums matters… a lot!
ADOLESCENCE IS A PERIOD of life in which many physical and emotional changes take place. There is solid scientific evidence that gum diseases can increase during adolescence as a consequence, among other reasons, of the lack of motivation in practising adequate oral hygiene. Adolescence is a complicated period in which the adolescent seeks his or SECTION CO-ORDINATED BY: MORE AND MORE STUDIES relate Almost two thirds of her own identity, and this sometimes Mª Cristina Serrano periodontal disease with cancer. The patients with one type of separates them from the routine of oral Master’s degree in periodontology connection tends to come from systemic hygiene created by their parents over the and implants. Complutense oesophageal cancer present inflammation that is produced as a years. However, it has been shown that University of Madrid response to periodontitis, provoking a characteristic periodontal pathogen the effort of parents to create these habits an increase in various inflammatory of oral hygiene during childhood have proteins that tend to be linked also their reward, because those who have to the complex alterations which are in the cancerous tissue, but not in managed to maintain good habits until produced in the development of cancer. the healthy oesophageal tissue of the 13 years of age have more probability of The oesophagus is a critical control patients. continuing to brush their teeth and use muscular tube in the passage of food This finding suggests two possible dental floss than children who have never from the oral cavity to the stomach, explanations: either the cells of been shown proper oral care. with two main types of cell that are oesophageal cancer are a preferred Furthermore, it is known that the implicated in the two main types of niche of the pathogen to multiply increase of sexual hormones – such as oesophageal cancer: adenocarcinoma itself, or P. gingivalis facilitates progesterone and oestrogen – during and squamous cell cancer. the development of cancer of the adolescence provokes a rise in the blood Researchers at the Faculty of oesophagus. supply in the gums. This can cause Dentistry at the University of Louisville In the latter case, the future greater bleeding and inflammation; the (USA) have found a periodontal implications could be huge, although adolescent can have gums that are more pathogen – Porphyromonas gingivalis more studies are needed that are able to inflamed, blotchy, and painful. – in 61% of patients with squamous cell reproduce these results and understand In some cases, it will be necessary cancer of the oesophagus. They have what is the true connection between that the dentist recommend periodontal determined the both the presence of this periodontal pathogen and cancer of treatment to help prevent damage to the an enzyme specific to this pathogen the oesophagus. tissues and bones that surround the teeth. and remains of its DNA could be found www.cuidatusencias.es Periodontal health, a priority Brushing the of people with tongue is more important than kidney disease you think
CHRONIC KIDNEY disease (CKD) is damage to a kidney characterised by reduced function (glomerular filtrate <60 ml/min) and which has three or more months of evolution. It tends to be related to advanced age, diabetes, obesity, and cardiovascular disease, and the final stage of this disease is kidney failure.
Treating oral and THE TONGUE IS an organ composed periodontal infections of 18 muscles that are involved in a must be a priority for multitude of very important functions, patients with chronic such as the perception of tastes, swallowing, and the articulation of kidney disease sounds. The anatomy of the back of the tongue is very rough, which encourages In recent years, a multitude of the accumulation of a very complex studies have been carried out that bacterial biofilm, implicated both in the have sought to provide evidence of a relationship between periodontitis being edentulous (that is to say, with and CKD. one or more missing teeth). REGULAR BRUSHING OF The mechanism of association Equally, it has been shown that THE TONGUE REDUCES BAD that has been proposed is through mortality for any reason after 10 BREATH AND IMPROVES THE systemic inflammation. The years of people with CKD without SENSE OF TASTE periodontal pathogens would have periodontitis was 32% while the ability to adhere to, invade, and in patients with both CKD and appearance of halitosis and the creation proliferate in the endothelial cells of periodontitis the rate increased to of a reserve of periodontal pathogens renal vascularization. 41%, a percentage comparable to the that can contribute to keeping gum In addition, a state of chronic mortality of patients with both CKD disease active. inflammation would be produced, and diabetes. Regular brushing of the tongue with an increase of C-reactive As a result, it is surmised that (whether with a toothbrush or with a protein and other mediators of treating oral and periodontal specific tongue cleaner), in particular inflammation, which would also infections must be a priority in aiding the removal of the layer that provoke a dysfunction in the wall of patients with CKD, above all in those covers the tongue, has been shown to the kidney’s blood vessels. who also have diabetes. reduce bad breath and improve the sense The results have recently been of taste. It also helps prevent caries, presented of a large epidemiological gingivitis, and periodontitis by eliminating study in the USA (NHNANES the pathogens that are stored there. III), in which 13,794 people were It is advisable to visit the dentist when evaluated over an average period of changes in the look of the tongue are 14.3 years. Among other findings, observed or when ulcers or lesions that researchers saw that patients last for more than two weeks appear, as with CKD had more likelihood of these can be a symptom of the presence suffering a periodontal disease or of of more serious diseases.
Superficial inflammation of the gums. Bleeding is the GIN- main warning sign. If it is not GIVI- treated properly it can develop into TIS. periodontitis.
Deep inflection of the gums and the other tissues that support the tooth. PERIO- It can lead to the loss of teeth. It has DON- repercussions for general health: it increases the risk of cardiovascular TITIS. disease, diabetes, and preterm birth.
ccuidatuseuida tus necnícasía.ess.
2 times a day, act: Every 3 months Every 6 months
Brush your Use dental Strengthen your Get a new Visit your dentist 1 gums and 2 floss or 3 hygiene with a 4 toothbrush 5 or periodontist for 1 teeth using 2 interdental 3 mouth rinse 4 5 a gum check-up a toothpaste brushes and to have your mouth cleaned
SEPA recommends the use of products that are scientifically endorsed.
Risk factors Warning Signs Simple Treatments
• Smoking. • Bleeding or reddening • Improve oral hygiene. • Stress. of the gums • Complete cleaning of bacterial
• General Diseases • Bad breath plaque on the gums. or lowered defences: • Hypersensitivity to cold • Evaluation diabetes, osteoporosis, HIV, • Mobility or separation of periodontal status. herpes, transplants, etc… of teeth. • Control of plaque and bacteria • Hormonal changes: • Loss of teeth. below the gums (scaling). pregnancy, menopause. • In advanced cases, • Family history. minor surgery.