Oral health: a matter of lifestyle

Active Care
2017-09-14

Research has confirmed that oral health affects systemic health and that compromised systemic conditions affect the health of the oral cavity.

The solution to respond to the health concept conjugated by OMS  as a psycho-physical-environmental confort  is to rely on lifestyle medicine as a basic "therapeutic choice".

Hippocrates had already paved the path for decision making in therapy to all medical practitioners: "Primum non nocere".

Fig. 1

Img. 1 – He is considered a precursor because he usually prescribed changes to his patients' lifestyle, such as diet and physical exercise, to treat diseases such as diabetes. His convinction about the actual benefit that his assistants obtained through the application of these principles is contained in two of his best known aphorisms: "Let food be thy medicine and medicine be thy food" and " Walking is the best medicine". Physical activity, a proper and balanced diet, and an effective stress management, are the active principles which regulate Lifestyle Medicine. Intense changes in lifestyle require knowledge and action, both on the practitioner's and on the patient's side. Professionals often do not sufficiently commit themselves to knowledge or, above all, to teaching these things, hence, patients find the application of the same too difficult to put into practice.

Fig. 2

Img. 2 – The keyword is intensive change in lifestyle; lifestyle medicine at Harvard medical school of Boston has produced evidence that shows how much emotional and social health can lower the risk of premature death, of contracting systemic diseases and/or improve their course, if they were already developed in the body. Confirmed as a risk index for diseases, alcohol and smoking are wrongly considered a solution to relieve major and widespread uneasinesses such as isolation, loneliness and depression.

Fig. 3

Img. 3 – The professional dental hygienists and dentists have the moral duty to update operational protocols, incorporating a motivational approach to change their patients' lifestyle. The change doesn't happen on a threatening indication of the professional. The compliance has been overtaken by Concordance in which the patient becomes an active part of the change, aware and grateful for the health benefits offered by lifestyle medicine, a therapeutic resource without side effects and suitable for all patients in systemic and oral healthcare. Identifying the risk index for the oral cavity is crucial because the tooth, immersed in the oral environment after its eruption, must be considered in dynamic equilibrium with oral fluids; on the other hand the enamel surface is exposed to: – chemical trauma (pH variation, consumption of beverages and acid foods) – physical trauma (mastication / malocclusion, improper use of home and/or professional oral hygiene tools). Research has confirmed the risks for periodontal health, such as bad control of the biofilm due to ineffective brushing, presence of untreated systemic diseases, hormonal imbalances, presence of stress (that promotes bruxism), smoking, lack of sleep and night-time apnea, lack of physical activity, improper diet.

Fig. 4

Img. 4 – All professionals, dentists and especially dental hygienists, to express effective prevention that responds to scientific evidence, must choose the appropriate technology in clinical protocols, to make them minimally invasive and easily manageable by the patient, according to the different clinical situations. It's appropriate to commit to leading the patient in changing to correct lifestyles, in the important role of dental coach. The goal is to choose therapeutic success strategies for maintaining systemic and oral health and the active collaboration of the patient to the lifelong health plan.

Fig. 5

Img. 5 – The concept of compliance, in which the patient responded passively to what the professional indicated, is overcome. Modern Active Care is based on concordance, in which the patient is active in therapeutic choices and interacts with the professional, sharing opportunities and the will to preserve health and well-being, becoming active in the behavioral change towards healthy lifestyles. The patient must feel the responsibility to change unhealthy behaviors (improper diet, excess caloric intake, lack of physical activity, smoking) and the control of biomarkers related to risk (blood lipids, hypertension, hyperglycaemia, obesity). The bacterial biofilm control remains a major factor for the health of the oral cavity. Which goals should hence be taken in oral hygiene – effective disorganization of bacterial biofilm – removing nutrients – effective brush control – personalization of instruments, methods, ideal times, depending on the type of hard and soft tissue of the oral cavity – careful observation of the patient's natural character typology to guide the proper choice – manual control to guide the correct choice of home hygienic tools

 

Health maintenance requires professionals do adopt an integrated approach between a constant critical evaluation of scientific evidence, a careful analysis of the patient’s bio-psycho-social aspects, a good clinical experience and availability to share with him the appropriate therapeutic choice, reminding that the patient requires highly aesthetic therapies that can improve his social interaction in life.