Interview with Dr Michaël LUMBROSO

Votre Quotidien - Avoir de belles dents by YVELINESPREMIERE

Here is a summarised transcript of theinterview with Dr Michaël LUMBROSO, broadcast on the local channel Yvelines Premièreon 14 February 2012.


- At what age should we start brushing our teeth? How do you do it? With what? How often? And afterwards?

Teeth should be brushed as soon as the first milk teeth appear!

• 0-3 years: brushing by parents with an age-appropriate manual toothbrush and a toothpaste containing less than 500 ppm fluoride.
• Between 3 and 6 years: I recommend the use of an electric brush, one that combines a rotating and pulsating movement, under the control of an adult (who can complete the brushing). Toothpaste should contain 500 ppm of fluoride. Toothpastes under 6 years of age are designed to be swallowed, so care should be taken with concentrations to avoid overdosing.
• From the age of 6, when children can spit, the ideal concentration is between 1000 and 1500 ppm. Ideally, teeth should be brushed at least twice a day, after meals. Brushing in the evening is particularly important as salivation decreases during the night, so teeth must be clean to limit the risk of caries. Do not eat or drink anything other than water after brushing!

    

- Is it serious to have cavities in baby teeth?

Yes it is serious!!! Caries is an INFECTIOUS and TRANSMISSIBLE disease!!! Having cavities on the milk teeth shows that the child is a carrier of cariogenic bacteria (Streptococcus Mutans and Acidophilus Lactobacillus), that all the conditions for cavities to form are met, and that there is therefore a very strong chance that this child will develop cavities on the permanent teeth.
In the world, 5 billion people are affected by caries (between 60% and 90% of the population depending on the country). In France, 50% of children aged 12 are affected.

Moreover, there is a pathology called "bottle syndrome" which can have serious consequences, leading to the loss of all the milk teeth ==> problems with phonation, language learning, nutrition, etc...

- How do they arise? Are we all equal?

See the Caries Prevention Fact Sheet here
For caries to occur, 4 factors must be present at the same time:

• Cariogenic bacteria: Streptococcus Mutans and Acidophilus Lactobacillus which form plaque
• Sugar
• De l’acide (pH <5,5, par exemple le Coca a un pH de 2,3 !!!
• Time ==> importance of brushing

 Intrinsic factors (enamel quality ==> role of fluoride, saliva efficiency)

- What do you think of fluoride supplements for children?

First of all, fluoride remains a major element in the prevention of dental caries. The latest studies show that its action is more important when used locally than systemically.
The recommended dose is 0.05 mg/Kg per day. Table salts are fluoridated, drinking water is fluoridated (especially some sparkling waters), and children's toothpastes supplement this dietary intake. Therefore, according to the latest recommendations of the AFSSAPS 2008, no supplements should be given before the age of 6 months.
In children with a high risk of caries, and after an assessment of fluoride intake, the dental surgeon may in some cases prescribe fluoride supplementation. But above all he can apply fluoride varnish or gels and seal the grooves.

- What do you think about the (over)consumption of chewing gum?

After a meal, when you can't brush your teeth, chewing sugar-free chewing gum has several advantages:

• cleaning of the teeth by mechanical effect,
• salivation ==> rise in pH,
• and some chewing gums contain xylitol (this is a sweetener that stops the proliferation of cariogenic bacteria) ==> this is very positive. Especially for patients with saliva deficiency, or an acidic mouth.

- Do they replace good tooth brushing?

NO, not at all, but it is better than nothing!

- Can they really have whitening properties?

Firstly, to date, the only known way to really whiten teeth is to use hydrogen peroxide derivatives, but I can't see chewing gum manufacturers adding hydrogen peroxide to chewing gum!
But these products, like whitening toothpastes for that matter, may contain abrasive agents that can damage the enamel layer! So I am not at all in favour of these products. If you want to have whiter teeth, the 40,000 French dentists will be happy to answer your questions.

- What about trendy smile bars?

See the Smile Bars fact sheet here

• They are developing in response to a growing demand for aesthetics ==> demand for health and well-being ==> motivation towards more prevention, which is rather positive.
• But the staff in these bars are not trained, so there is no screening, no diagnosis. Sometimes bleaching can be contraindicated (cavities, gingivitis, pregnancy, demineralisation, etc.)
• Theoretically, only products with a concentration of no more than 0.1% hydrogen peroxide are considered to be cosmetic products, and therefore authorised in these shops. However, the lightening "performances" that these "bars" promise are not possible without the use of a more concentrated product (reserved for professional use), so there are two possibilities: either these promises are unfounded, and we are faced with false advertising, or the products used do not comply with the regulations and are used illegally! with the risks that this implies in terms of public health In any case, there is real doubt about the products used...
• no professional liability insurance (problem of dentistry abroad)

- What is the difference with in-office bleaching?

See here the Fact Sheet on Money Laundering

Assessment, screening, smile analysis, aesthetic diagnosis, photo taking, product concentration, chairside or outpatient techniques (custom-made trays), follow-up.

- When should you see your dentist?

At least once a year and remember that when it hurts, it's already too late!

- What are you looking at (gums, tartar, cavities, etc.)?

EVERYTHING! Joints, mucous membranes (cancer screening), teeth, gums, supporting tissues, sinuses, salivary glands.
Possibility of Individualised Dental Prophylaxis, scanner, panoramic. Change of diet in young adults, with consumption of soda, and dietary imbalance in young adults (18 years)

- What treatments do you offer?

Today, dentistry in France is essentially curative, whereas the scientific means to achieve preventive dentistry exist!
The profession of dentistry is no longer a matter of waiting for a hole to appear, then plugging it and waiting for the next one to appear. Implement a real policy of prevention and prophylaxis.

Progress in diagnosis(cone beam), inanaesthesia, in precision (microscope), in techniques (adhesion, zirconia) to preserve a maximum of healthy tissue.
And when one or more teeth are lost, the implants allow us to recover our dental capital.

- What are your tips for a beautiful mouth?

 For the prevention of caries: effective oral hygiene, a balanced diet (fibre and few fast sugars) + fluoride intake and a good salivary flow guarantee a low caries risk.
For the prevention of gum disease: Tobacco and plaque control
Orthodontics
Replace missing teeth!!! (one tooth to be replaced on average = 50 million missing teeth). Notion of gearing.
Prevention of bruxism

Interview with Dr Michaël LUMBROSO, Dental Surgeon in Versailles; broadcast on the local channel Yvelines Première on 14 February 2012.